MULTILEVEL SOCIOECONOMIC AND REGIONAL DISPARITIES IN MATERNAL HEALTHCARE ACCESS IN A HIGH-BURDEN SETTING
Author(s)
Tarilate C. Temedie-Asogwa, MSc, PharmD1, Augustus Osborne, MPH2, Julie A. Atta, MPH3, Mohammad Al Zoubi, MBA3, Sia Dauda, MPH3, Osaro Mgbere, PhD, MS, MPH1, Ekere J. Essien, MD, DrPH1;
1University of Houston College of Pharmacy, Houston, TX, USA, 2Institute for Development, Freetown, Western Area, Sierra Leone, Freetown, Sierra Leone, 3The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
1University of Houston College of Pharmacy, Houston, TX, USA, 2Institute for Development, Freetown, Western Area, Sierra Leone, Freetown, Sierra Leone, 3The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
OBJECTIVES: Barriers to maternal healthcare access remain a major public health challenge in many low- and middle-income, high-burden settings. Despite sustained investments in maternal health, large segments of women continue to face obstacles to timely and quality care due to persistent socioeconomic and structural inequities. This study examined individual- and regional-level determinants of barriers to maternal healthcare access among women of reproductive age in a high-burden context.
METHODS: We conducted a cross-sectional analysis of data from the 2018 Nigeria Demographic and Health Survey, including 41,821 women aged 15-49 years, representing a nationally weighted population of women of reproductive age. Barriers to healthcare access were operationalized using four standardized DHS indicators capturing financial, geographic, and social constraints. Descriptive statistics were used to estimate prevalence, and multilevel mixed-effects logistic regression models were applied to examine individual- and contextual-level predictors. Results are reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).
RESULTS: Overall, 51.5% (95%CI: 50.3-52.8) of women reported experiencing at least one barrier to maternal healthcare access. Lower odds of barriers were observed among women with higher education (aOR=0.60; 95%CI: 0.51-0.71), those who were married (aOR=0.66; 95%CI: 0.5-0.75), women with health insurance coverage (aOR=0.46; 95%CI: 0.34-0.62), media exposure, and those in higher wealth quintiles. In contrast, higher odds of barriers were found among divorced women (aOR = 1.28; 95% CI: 1.01-1.64), women with four or more children (aOR = 1.29; 95% CI: 1.10-1.50), and rural residents (aOR = 1.29; 95% CI: 1.09-1.51). Marked regional disparities were evident, with higher barriers in some regions and lower in others.
CONCLUSIONS: These findings highlight substantial socioeconomic and regional inequities in maternal healthcare access within a high-burden context. Equity-oriented, region-specific policies that strengthen financial risk protection, improve service availability, and address community-level barriers are crucial for enhancing maternal health outcomes and progress toward Sustainable Development Goal 3.
METHODS: We conducted a cross-sectional analysis of data from the 2018 Nigeria Demographic and Health Survey, including 41,821 women aged 15-49 years, representing a nationally weighted population of women of reproductive age. Barriers to healthcare access were operationalized using four standardized DHS indicators capturing financial, geographic, and social constraints. Descriptive statistics were used to estimate prevalence, and multilevel mixed-effects logistic regression models were applied to examine individual- and contextual-level predictors. Results are reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).
RESULTS: Overall, 51.5% (95%CI: 50.3-52.8) of women reported experiencing at least one barrier to maternal healthcare access. Lower odds of barriers were observed among women with higher education (aOR=0.60; 95%CI: 0.51-0.71), those who were married (aOR=0.66; 95%CI: 0.5-0.75), women with health insurance coverage (aOR=0.46; 95%CI: 0.34-0.62), media exposure, and those in higher wealth quintiles. In contrast, higher odds of barriers were found among divorced women (aOR = 1.28; 95% CI: 1.01-1.64), women with four or more children (aOR = 1.29; 95% CI: 1.10-1.50), and rural residents (aOR = 1.29; 95% CI: 1.09-1.51). Marked regional disparities were evident, with higher barriers in some regions and lower in others.
CONCLUSIONS: These findings highlight substantial socioeconomic and regional inequities in maternal healthcare access within a high-burden context. Equity-oriented, region-specific policies that strengthen financial risk protection, improve service availability, and address community-level barriers are crucial for enhancing maternal health outcomes and progress toward Sustainable Development Goal 3.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR88
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity, Insurance Systems & National Health Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Reproductive & Sexual Health