Inequities in Access to Maternal Health Care in Enugu State: Implications for Universal Health Coverage to Meet Vision 2030 in Nigeria

We explored the equity issues in access to maternal health services in Enugu State, Nigeria. We conducted a cross-sectional survey of 1,600 women who had babies within 6 months prior to the survey, drawn from four urban and rural local government areas in Enugu State of Nigeria, using structured questionnaire. Focus group discussions were held with grandmothers and fathers of the new babies. In-depth interviews were held with health workers. Results showed that inequities exist in access to quality health service when the mothers needed health care. The inequities in access to quality antenatal care (ANC) services were driven mainly by the type of localities of the mothers. Mothers who lived in the urban areas had better access (p = .013). Other factors that facilitated access to better ANC services included being educated (p = .049), being older (p = .009), and belonging to the richer wealth quintile (p < .001). With respect to access to health service when in need of health, differentials were seen with respect to living in urban residence (p < .001), distance to the health facilities (p < .001), and being rich (p < .001). Access to health services was associated with odds ratio of 3.6 (95% CI [2.9, 4.4]) and 1.54 (95% CI [1.3, 2.0]) for living in urban residence and existence of good ANC service points, respectively. Similarly, living in urban areas was associated with an odds ratio of 1.3 (95% CI [1.1, 1.6]) of having access to good ANC services. These inequities in access to health service were also captured in the qualitative data. Suboptimal access to quality health care by segments of the populations poses challenge to universal health coverage in Enugu State. Action is needed to promote coordinated delivery of health services to ensure no one is left behind, irrespective of where they live or the socioeconomic strata they are born into.