Understanding urban-rural inequality in early maternal discharge following facility-based vaginal delivery in...

The objective of this study was to estimate the urban-rural gap in early maternal discharge following facility-based delivery in Nigeria. A sample of 8614 women aged 15-49 years with national representativeness was extracted and analysed. Multivariate decomposition analysis and concentration index were used to examine the prevalence and urban-rural inequality in early maternal discharge after facility-based vaginal delivery. Approximately 65.6% of rural women and 50.5% of urban dwellers reported early maternal discharge. There was pro-poor distribution of early maternal discharge. The concentration index for rural residence was -0.0817 (SE = 0.0063; p < 0.001) and was -0.0346 (SE = 0.0083; p < 0.001) for urban residence. About 17.6% of early maternal discharge gap was explained by the differences in distributions of characteristics (endowments) between urban and rural residence, while 82.4% of early maternal discharge gap was due to the differences in the distribution of unexplained factors between urban and rural residence. In the multivariate decomposition analysis, having multiple birth, secondary or higher educational levels, moderate or high decision making power, and being from South South geographical region narrowed the urban-rural gap in early maternal discharge. On the other hand, delivery at a private health facility, having 5 + members of household, being from North East, South East and South West geographical region respectively, widened the urban-rural gap in early maternal discharge. The urban-rural gap widened by the disproportionate distribution of women with higher educational level, use of private health facility, large household size and residence in regions like the North East, South East, and South West. These patterns underscore the importance of context-specific interventions that address both structural and individual-level drivers, to ensure equitable postnatal care regardless of geographic or sociodemographic background.