Socio-economic inequality in Maternal Health Services Utilization in Ethiopia: Scoping Review.
1
Health Economics and Policy, Freelancer, Addis Ababa, Ethiopia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
ABSTRACT:
Ethiopia has made significant strides in reducing maternal and neonatal mortality, achieving a 61% reduction in the MMR between 2000 and 2017. However, these national-level successes coexist with entrenched, systemic inequalities in maternal health service utilization. This scoping review systematically maps the available evidence on the nature, extent, and determinants of socio-economic inequality in maternal health service utilization in Ethiopia. The scoping review was conducted in accordance with the methodological framework outlined by Arksey and O'Malley and the guidance provided by the Joanna Briggs Institute (JBI) for scoping reviews. The scoping review was synthesized findings from various studies and based on the review questions which were framed using the Population, Concept, Context (PCC) framework. A comprehensive three-step search strategy was employed to identify all relevant literature. A total of 76 reviewed articles and documents included for the review process. Reviewed studies have consistently demonstrated a strong correlation between a woman's economic status and her utilization of maternal health services with the overall concentration index of 0.25 (rural residents 0.15 and an urban resident 0.15). Educational status contributes to inequality in maternal health service utilization, contributing to disparity in antenatal care and delivery care utilization. The difference in service utilization between urban and rural residents was 20.3 percentage points for ANC four, 25.1 percentage points for Skilled Birth Attendance (SBA), and 26.6 percentage points for Postnatal Care (PNC). This inequity is further exacerbated at the subnational level and data shows significant regional inequalities. Socioeconomic and geographic inequalities are not incidental; they are the primary drivers of disparities in the utilization of essential maternal health services. A woman's household wealth, level of education, and place of residence collectively create a powerful, synergistic effect that either facilitates or obstructs her access to care.
Ethiopia has made significant strides in reducing maternal and neonatal mortality, achieving a 61% reduction in the MMR between 2000 and 2017. However, these national-level successes coexist with entrenched, systemic inequalities in maternal health service utilization. This scoping review systematically maps the available evidence on the nature, extent, and determinants of socio-economic inequality in maternal health service utilization in Ethiopia. The scoping review was conducted in accordance with the methodological framework outlined by Arksey and O'Malley and the guidance provided by the Joanna Briggs Institute (JBI) for scoping reviews. The scoping review was synthesized findings from various studies and based on the review questions which were framed using the Population, Concept, Context (PCC) framework. A comprehensive three-step search strategy was employed to identify all relevant literature. A total of 76 reviewed articles and documents included for the review process. Reviewed studies have consistently demonstrated a strong correlation between a woman's economic status and her utilization of maternal health services with the overall concentration index of 0.25 (rural residents 0.15 and an urban resident 0.15). Educational status contributes to inequality in maternal health service utilization, contributing to disparity in antenatal care and delivery care utilization. The difference in service utilization between urban and rural residents was 20.3 percentage points for ANC four, 25.1 percentage points for Skilled Birth Attendance (SBA), and 26.6 percentage points for Postnatal Care (PNC). This inequity is further exacerbated at the subnational level and data shows significant regional inequalities. Socioeconomic and geographic inequalities are not incidental; they are the primary drivers of disparities in the utilization of essential maternal health services. A woman's household wealth, level of education, and place of residence collectively create a powerful, synergistic effect that either facilitates or obstructs her access to care.
| eISSN: | 2654-1459 |
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