Inequalities in effective coverage of the maternal healthcare continuum in Cameroon: a cascade analysis from service...

Maternal healthcare (MHC) in Cameroon reflects the persistent challenges in Sub-Saharan Africa, where high maternal mortality continues despite improved service utilization, stressing inequitable effective coverage (EC). This study applied EC cascade analysis-including service contact, continuity, and input-adjusted coverage-to quantify geographic and socioeconomic disparities, informing equity-focused strategies to dismantle structural barriers in the MHC continuum.

We combined population and health facility data (2018 Cameroon Demographic and Health Survey and 2015 Emergency Obstetric and Neonatal Care Assessment) to estimate the input-adjusted coverage of antenatal care (ANC) and intra-and postpartum care (IPC). Inequalities were assessed using absolute and relative measures.

The MHC cascade showed significant falls in input-adjusted coverage. For ANC, 86.3% service contact eroded to 25.3% continuity and 14.4% input-adjusted coverage. For IPC, the service continuum dropped from 51.4 to 31.4% input-adjusted coverage, revealing steeper losses compared to ANC (20.0% vs. 10.9%). When accounting for service readiness, relative inequalities intensified (e.g., the wealth-based RII for ANC increased by 122%), while absolute gaps narrowed (SII declined by 25%), indicating a greater loss of coverage among socioeconomically privileged groups (IPC input-adjusted coverage dropped by 20.9% for the highest quintile vs. 11.1% for the lowest quintile). At the same time, marginalized populations experienced compounded exclusion-facing severely limited access to care and substandard service quality at available facilities-highlighting the critical need to improve both access and quality.

Cameroon's MHC disparities stem from systemic resource and quality gaps. Integrating absolute and relative inequality metrics into policy frameworks can dismantle structural biases, aligning interventions with continuum-of-care strategies to prevent avoidable mortality.