Wealth-based equity in essential newborn care practices in Ethiopia: A cross-sectional study

Area of Science:

• Maternal and Child Health
• Health Equity Research
• Global Health

Background:

• Essential newborn care practices are vital for infant survival globally.
• Ethiopia faces challenges with equitable access to these practices, especially concerning place of birth.
• The link between socioeconomic status and newborn care based on delivery location requires further investigation.

Purpose of the Study:

• To assess wealth-based equity in essential newborn care (ENC) practices in Ethiopia.
• To compare ENC equity between facility-based and home deliveries.
• To identify specific ENC practices with significant socioeconomic disparities.

Main Methods:

• Utilized data from the 2019-2020 Performance Monitoring for Action Ethiopia survey (n=2,493 newborns).
• Household wealth quintiles were determined using principal component analysis of asset ownership.
• Analyzed wealth-based equity using equiplots, equity gaps, equity ratios, and concentration indices for facility and home births.

Main Results:

• Facility births demonstrated higher coverage of essential newborn care practices with minimal inequities.
• For home births, inequities were observed in skin-to-skin care and delayed bathing, favoring less poor households.
• Delayed bathing and proper cord care were more common in wealthier households overall, while skin-to-skin care and delayed bathing favored wealthier groups in home births.

Conclusions:

• Facility deliveries are associated with higher coverage of essential newborn care practices.
• Significant socioeconomic inequities in skin-to-skin care and delayed bathing persist for home births.
• Strategies must focus on improving equity in newborn care within facilities and promoting facility births while enhancing home-based newborn care practices in Ethiopia.