article · PLoS ONE
This study investigated urban-rural disparities in the receipt of treatment for obstetric complications among postpartum women in Ethiopia, using nationally representative data from 2021-2023. It found that 61.4% of women with complications received treatment, but urban women had a significantly higher rate (80.1%) compared to rural women (55.3%), a 24.6 percentage point difference. A multivariate decomposition analysis revealed that differences in women's characteristics, such as wealth status and place of delivery, largely drove this disparity. Differences in how these characteristics translated into treatment partially offset the gap. The findings highlight a substantial inequality in access to care.
Understanding the factors contributing to urban-rural disparities in obstetric complication treatment is vital for improving maternal health outcomes in Ethiopia. Addressing these inequalities can reduce maternal morbidity and mortality, ensuring more equitable access to life-saving care for all women, especially in underserved rural areas.
The abstract does not indicate a direct commercialisation pathway for a product or service. Instead, it provides evidence-based insights for public health policy and programme development. These findings can inform government agencies, non-governmental organisations, and international aid organisations in designing and implementing targeted interventions, such as financial support schemes and improved maternal health service delivery models, to reduce health inequalities in Ethiopia. This is applied research for public health programme design.
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BACKGROUND: Reducing disparities in access to emergency obstetric care is crucial for decreasing maternal morbidity and mortality, particularly in low-resource settings where inequitable access remains a major challenge. While systematic monitoring and analysis of these disparities are essential for developing effective interventions, urban-rural disparities in Ethiopia remain understudied. Therefore, this study aimed to assess urban-rural disparities and identify factors contributing to disparities in treatment receipt for obstetric complications among postpartum women six weeks after childbirth in Ethiopia. METHODS: We analyzed nationally representative Performance Monitoring for Action (PMA) Ethiopia cohort data (2021-2023), including a weighted sample of 884 postpartum women who reported obstetric complications. Logit-based multivariate decomposition was used to quantify urban-rural disparities in the receipt of treatment and to identify contributing factors. Statistical significance was determined at p < 0.05, with 95% confidence intervals. RESULTS: In Ethiopia, 61.4% (95% CI: 54.7-68.1%) of women received treatment for obstetric birth complications. Urban women had a higher treatment rate (80.1%) than rural women (55.3%), showing a 24.6 percentage point difference, indicating a high level of inequality. The decomposition analysis showed that endowment effects explained 153% of the disparity, while coefficient effects contributed -53.4%, indicating that differences in characteristics drive the gap, whereas differences in how these characteristics translate into treatment partially offset it. Significant endowment components explaining the disparity included: the 35-49 age category (-7.5%), Muslim religion (4.8%), rich wealth status (75%), birth preparedness discussions during antenatal care (1.9%), and facility delivery (73%). For the coefficient components, the significant contributing factors were: ages 25-34 years (26%), ages 35-49 years (24.4%), and having four or more ANC visits (-28.4%). CONCLUSION: Substantial urban-rural disparities in treatment receipt for obstetric complications exist in Ethiopia, driven by differences in both endowment and coefficient effect components. To address this gap, long-term strategies should address underlying socioeconomic disparities. In the short term, targeted interventions such as financial support for disadvantaged rural women, enhancing financial protection mechanisms, and improved maternal health services, particularly health facility delivery and birth preparedness initiatives, could narrow the disparity.
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DOI: 10.1371/journal.pone.0355684
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