Geographical and Socioeconomic Inequalities in Maternal Mortality in Ethiopia

In Ethiopia, social inequalities are common among women residing in deprived communities and between the poor and the rich. This study aimed to assess geographical and socioeconomic inequalities in maternal mortality using nationally representative data from Ethiopian Demographic and Health Surveys conducted from 2000 to 2019 (inclusive). Four health-related geographical and socioeconomic factors were assessed. Four relative and absolute health-related inequality measures were also used: rate difference, rate ratio, population attributable risk, and population attributable fraction. A total of 61,610 sister siblings were included. The highest reported inequalities in maternal mortality were residence-related (46% in 2005 among rural women), region-related (66% in 2005 among women in Beshangul-Gumuz regional state), education-related (83% in 2011 among women with primary education), and wealth-related (47% in 2000 among poorer women). So, if education-related inequalities in maternal mortality alone had been averted, the national maternal mortality could have been reduced by 52% in 2000, 51% in 2005, 83% in 2011, and 76% in 2016. In conclusion, inequalities in maternal mortality were high and concentrated among poorer women, women with lower educational status, and rural areas. Therefore, reducing the effects of poverty including social determinants of maternal mortality is recommended.