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Spatio-temporal disparities in maternal health service utilization in Rwanda: What next for SDGs?

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  • Kpienbaareh, Daniel
  • Atuoye, Kilian N.
  • Ngabonzima, Anaclet
  • Bagambe, Patrick G.
  • Rulisa, Stephen
  • Luginaah, Isaac
  • Cechetto, David F.

Abstract

The Sustainable Development Goals (SDGs) in part aim to further improve maternal health outcomes by reducing spatial disparities in utilization of critical services such as antenatal and assisted delivery, with emphasis on decentralization and integration of strategies. Yet, our understanding of within country spatial disparities in maternal health services (MHS) utilization over time has been scant. By fitting multiple regression models to a pooled dataset of the 2010/11 and 2014/15 Rwanda Demographic and Health Surveys (n = 12,273), and employing post-estimation margins analysis, we examined spatial differentiation of MHS trends prior to the SDGs in Rwanda. Our study found that women in 2014/15 were more likely to utilize antenatal services and assisted delivery (OR = 1.757, p ≤ 0.001) compared with 2010/11, but with nuanced spatial variations. Compared with Nyarugenge, women in nineteen out of the twenty-nine remaining districts were more likely to report utilization of antenatal services and skilled birth delivery, while the probability of accessing four or more antenatal services in seven districts declined between 2010/11 and 2014/15. Physical, financial and socio-cultural factors were associated with maternal health service utilization over the period. Based on our findings, we present policy suggestions for improving utilization of MHS in Rwanda and in similar contexts in the SDGs period.

Suggested Citation

  • Kpienbaareh, Daniel & Atuoye, Kilian N. & Ngabonzima, Anaclet & Bagambe, Patrick G. & Rulisa, Stephen & Luginaah, Isaac & Cechetto, David F., 2019. "Spatio-temporal disparities in maternal health service utilization in Rwanda: What next for SDGs?," Social Science & Medicine, Elsevier, vol. 226(C), pages 164-175.
    • Handle: RePEc:eee:socmed:v:226:y:2019:i:c:p:164-175
    DOI: 10.1016/j.socscimed.2019.02.040
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    1. Bukenya, Badru & Golooba-Mutebi, Frederick, 2020. "What explains sub-national variation in maternal mortality rates within developing countries? A political economy explanation," Social Science & Medicine, Elsevier, vol. 256(C).
    2. Samuel Manda & Ndamonaonghenda Haushona & Robert Bergquist, 2020. "A Scoping Review of Spatial Analysis Approaches Using Health Survey Data in Sub-Saharan Africa," IJERPH, MDPI, vol. 17(9), pages 1-20, April.
    3. Tuyisenge, Germaine & Crooks, Valorie A. & Berry, Nicole S., 2020. "Using an ethics of care lens to understand the place of community health workers in Rwanda's maternal healthcare system," Social Science & Medicine, Elsevier, vol. 264(C).
    4. Bianca R Ziegler & Moses Kansanga & Yuji Sano & Joseph Kangmennaang & Daniel Kpienbaareh & Isaac Luginaah, 2021. "Antenatal care and skilled birth in the fragile and conflict‐affected situation of Burundi," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(4), pages 1081-1106, July.
    5. Tao, Zhuolin & Cheng, Yang & Du, Shishuai & Feng, Ling & Wang, Shaoshuai, 2020. "Accessibility to delivery care in Hubei Province, China," Social Science & Medicine, Elsevier, vol. 260(C).
    6. Ziegler, Bianca R. & Kansanga, Moses & Sano, Yuji & Kangmennaang, Joseph & Kpienbaareh, Daniel & Luginaah, Isaac, 2020. "Antenatal care utilization in the fragile and conflict-affected context of the Democratic Republic of the Congo," Social Science & Medicine, Elsevier, vol. 262(C).

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