Global health status in general and maternal mortality in particular, showed positive progress in the last 20 years in the developing world. Ethiopia has a good record in achieving the Millennium Development Goals (MDGs) related to child mortality and maternal mortality reduction. Although such positive results have been reported, there is a huge disparity in the utilization of high-impact interventions for maternal health including births assisted by skilled health personnel (SBA) in different population groups. Equitable health service provision is the center pace of many global initiatives such as Sustainable Development Goals (SDGs), Universal Health Coverage (UHC) and the International Conference on Population and Development (ICPD) to improve maternal and child health.
This study was conducted based on Ethiopian Demographic and Health Surveys (EDHS). The decomposition analysis of the EDHS of 2000, 2005, 2011, 2016 and 2019 were conducted. The source owners were asked officially to get access to raw data in SPSS format. Then the data on skilled birth attendance and associated geographic and socio-economic characteristics were extracted and analyzed using SPPS, EDHS Statcompiler and WHO HEAT tool kit.
In general, the proportion of birth attended by skilled health personnel increased from 5% in 2000 to 49.8% in 2019 in Ethiopia. However, the skilled birth attendant service utilization is highly different among socio-economic statuses and geographic differences. The urban resident women benefited more than those in rural. In the 2019 EDHS, women living in urban areas were 1.76 (95% CI 1.2-2.3) times higher to give birth with the assistance of skilled health professionals. The rate difference between women with higher education and no education showed an increasing trend from 42.4% (95% CI 34.6, 50.3) in 2000 to 69.1% in 2011 (95%CI: 60.8, 71.8) and started to decrease after 2011 from 69.1% in 2011 to 57.9% in 2019 EDHS. Based on the 2019 EDHS, the richest were 6.2 (95% CI; 4.9-8.2) times more likely to use SAB services compared to the poorest counterparts and the relative concentration of the SBA service utilization of EDHS 2016 was 31.5 (95% CI; 29.5, 33.4) for the richest in wealth quartile based analysis. The disparities in using SBA service persisted among different types of residence, geographical location, level of education of pregnant women and the wealth status of the household. In a ll cases, there is an increasing trend of using SBA services. Although the inequalities are significant, there is a tendency of reduction in the level of disparities in the relative concentration index of health status and differences among education levels. The urban residents, the richest and those with higher education level benefited more than their counterparts.
