Spatio-temporal disparities in maternal health service utilization in Rwanda: What next for SDGs?. (April 2019)

• Record Type: Journal Article
• Authors: Kpienbaareh, Daniel; Atuoye, Kilian N.; Ngabonzima, Anaclet; Bagambe, Patrick G.; Rulisa, Stephen; Luginaah, Isaac; Cechetto, David F.
• Is Part Of: Social science & medicine. Volume 226(2019)
• Page Start: 164
• Page End: 175
• Publication Date: 2019-04
• Subjects: Rwanda -- Maternal health service -- Antenatal care utilization -- Skilled birth delivery -- Sustainable development goals -- Millennium development goals; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2019.02.040
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: The Sustainable Development Goals (SDGs) in part aim to further improve maternal health outcomes by reducing spatial disparities in utilization of critical services such as antenatal and assisted delivery, with emphasis on decentralization and integration of strategies. Yet, our understanding of within country spatial disparities in maternal health services (MHS) utilization over time has been scant. By fitting multiple regression models to a pooled dataset of the 2010/11 and 2014/15 Rwanda Demographic and Health Surveys (n = 12, 273), and employing post-estimation margins analysis, we examined spatial differentiation of MHS trends prior to the SDGs in Rwanda. Our study found that women in 2014/15 were more likely to utilize antenatal services and assisted delivery (OR = 1.757, p ≤ 0.001) compared with 2010/11, but with nuanced spatial variations. Compared with Nyarugenge, women in nineteen out of the twenty-nine remaining districts were more likely to report utilization of antenatal services and skilled birth delivery, while the probability of accessing four or more antenatal services in seven districts declined between 2010/11 and 2014/15. Physical, financial and socio-cultural factors were associated with maternal health service utilization over the period. Based on our findings, we present policy suggestions for improving utilization of MHS in Rwanda and in similar contexts in the SDGs period. Highlights: Rwanda attained the maternal and child health targets during the MDGs. The country improved in universal health coverage, and efficiency in MHS delivery. However, spatial disparities still exist across districts and socioeconomic groups. Our analyses revealed nuanced spatiotemporal disparities in MHS utilization. Decentralizing integrated MHS would further improve equity in the SDGs era.