Inequities in maternal health services utilization in Ethiopia 2000-2016: magnitude, trends, and determinants

Background: Inequities in maternal health services utilization constitute a major challenge in maternal mortality reduction in Ethiopia. We sought to assess magnitude, trends, and determinants of inequities in maternal health services utilization in Ethiopia from 2000 to 2016. Methods: The study utilized data from the 2000 and 2016 Ethiopia Demographic and Health Surveys, which were done based on a cross sectional survey design. The wealth-related inequities were assessed by concentration curve and horizontal inequity indices. Trends in inequities were assessed by comparing the concentration indices of maternal health services utilization variables between the 2000 and 2016 surveys using Wagstaff two groups concentration indices comparison method. Finally, the inequities were decomposed into its contributing factors using Wagstaff method of analysis. Results: Wealth-related inequities were significantly high in 2016: with horizontal inequities indices and residual regression error of antenatal care, skilled birth attendance, and postnatal care service utilization (-0.09 and -0.01), (-0.06 and 0.01), and (-0.11 and 0.0001), respectively. These indices increased significantly in 2016 when it is compared with the 2000 indices' with the respective concentration indices difference of -0.05, 0.05, and -0.07. The related all p-values were < 0.0001. The main determinants of inequities were low-economic status, illiteracy, rural residence, no occupation, and fewer accesses to mass media. Conclusions: In Ethiopia, maternal health services utilization inequities were significantly high and increased in 2016 compared to 2000. Women who are poor, rural resident, uneducated, unemployed, and fewer mass media exposed are the most disadvantaged. Targeting maternal health interventions for the underserved women is essential to reduce maternal mortality in the country.