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Inequities in skilled attendance at birth in Namibia: a decomposition analysis
Eyob Zere1, Doyin Oluwole, Joses M Kirigia
1Africa's Health in 2010, Academy for Educational Development, Washington, DC 20009, USA. zeyob@yahoo.com
BMC Pregnancy and Childbirth
|May 17, 2011
Summary
Wealth and education disparities significantly drive unequal access to skilled birth attendants in Namibia, highlighting the need for multi-sectoral interventions beyond the health system to improve maternal health outcomes.
Area of Science:
- Public Health
- Health Equity
- Maternal Health
Background:
- Millennium Development Goal 5 (MDG5) targets improved maternal health, with global maternal mortality ratio (MMR) declining but masked by national and regional inequalities.
- Sub-Saharan Africa's MMR reduction is linked to increased skilled birth attendance, yet significant wealth-based disparities persist in Namibia.
- This study investigates the drivers of wealth-related inequalities in skilled birth attendance in Namibia.
Purpose of the Study:
- To identify the primary drivers of wealth-related inequalities in skilled birth attendance in Namibia.
- To analyze how socioeconomic factors influence access to skilled health providers during childbirth.
Main Methods:
- Analysis of Namibia Demographic and Health Survey data (2006-07).
- Application of a decomposable health concentration index.
- Utilizing the framework of the Commission on Social Determinants of Health to assess inequities.
Main Results:
- Approximately 80.3% of deliveries were attended by skilled health providers, with significant disparities based on wealth, education, and location.
- Skilled birth attendance was 70% higher in the richest quintile compared to the poorest and nearly double for educated women versus uneducated women.
- Wealth-related inequalities in skilled birth attendance favored economically better-off households (Concentration Index C = 0.0979; P < 0.001).
Conclusions:
- Maternal wealth and education are identified as the principal drivers of inequities in skilled birth attendance.
- Addressing disparities in childbirth services requires a multi-sectoral approach, extending beyond the healthcare system.
- Implementation of Primary Health Care principles is crucial for concerted action to reduce these inequalities.
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