Examining inequality of opportunity in the use of maternal and reproductive health interventions in Sierra Leone

  • Journal of Public Health (United Kingdom), Volume 42, No. 2, Year 2020

listen audio

Study Justification:
– Poor countries like Sierra Leone often have poor health outcomes and limited access to lifesaving health services.
– Maternal and reproductive health services are crucial for human development, especially in developing regions.
– Inequality in accessing and using these services is a persistent problem in many developing countries.
– There is a lack of empirical studies examining inequalities in maternal and reproductive health in Sierra Leone.
Study Highlights:
– Data from the Sierra Leone Demographic and Health Surveys conducted in 2008 and 2013 were used.
– Five maternal and reproductive health indicators were selected for the study.
– The Human Opportunity Index (HOI) was used to measure inequalities.
– Inequalities declined over time, as shown by the decrease in the dissimilarity index.
– The HOI increased for all selected maternal and reproductive health indicators.
– Antenatal services showed closer equality compared to other selected services.
– Household wealth status, maternal education, and place of residence were identified as important factors contributing to inequality.
Study Recommendations:
– Increase the educational levels of women to improve the use of maternal and reproductive health services.
– Improve the standard of living to reduce inequalities in accessing these services.
– Bring maternal and reproductive health services closer to rural populations.
Key Role Players:
– Government agencies responsible for healthcare and education policies.
– Non-governmental organizations (NGOs) working in the field of maternal and reproductive health.
– Community leaders and local healthcare providers.
– Researchers and academics specializing in public health and development.
Cost Items for Planning Recommendations:
– Investment in education programs to increase the educational levels of women.
– Infrastructure development to improve the standard of living.
– Expansion of healthcare facilities and services in rural areas.
– Training and capacity building for healthcare providers.
– Awareness campaigns and community outreach programs.
Please note that the cost items provided are general categories and not actual cost estimates.

N/A

Background: Poor countries, such as Sierra Leone, often have poor health outcomes, whereby the majority of the population cannot access lifesaving health services. Access to, and use of, maternal and reproductive health services is crucial for human development, especially in developing regions. However, inequality remains a persistent problem for many developing countries. Moreover, we have not found empirical studies, which have examined inequalities in maternal and reproductive health in Sierra Leone. Method We used data collected from the Sierra Leone Demographic and Health Surveys (DHS) conducted in 2008 and 2013. Five maternal and reproductive health indicators were selected for this study, including four or more antenatal care visits, skilled antenatal care provider, births delivered in a facility, births assisted by a skilled birth attendant, and any method of contraception. To measure inequalities, we adopted the Human Opportunity Index (HOI). Using this measure, we measured differentials over the two periods, and decomposed it to measure the contribution of the selected circumstance variables to inequality. Results: Inequalities declined over time, as shown by the decrease in the dissimilarity index. Due to the drop in the dissimilarity index, the HOI increased for all the selected maternal and reproductive health indicators. Moreover, antenatal services were closer to equality compared to the other selected services. Overall, we found that household wealth status, maternal education and place of residence, are the most important factors contributing to the inequality in the use of maternal and reproductive health services. Conclusions: Even though there are improvements in inequalities over time, there are variations in the way in which inequality within the different indicators has improved. In order to improve the use of maternal and reproductive health services, and to reduce inequalities in these services, the government will have to invest in: (i) increasing the educational levels of women, (ii) improving the standard of living, as well as (iii) bringing maternal and reproductive health services closer to rural populations.

N/A

The research findings suggest several recommendations to improve access to maternal health in Sierra Leone:

1. Strengthening Education: Investing in increasing the educational levels of women can have a significant impact on improving access to maternal health services. This can be achieved by implementing programs that focus on educating women about the importance of maternal health, reproductive rights, and family planning. Additionally, providing scholarships or incentives for girls to stay in school can help reduce disparities in education and empower women to make informed decisions about their health.

2. Improving Standard of Living: Addressing the socio-economic factors that contribute to inequality in accessing maternal health services is crucial. The government should focus on poverty alleviation programs, job creation, and income generation initiatives to improve the standard of living for vulnerable populations. This can include providing financial support for pregnant women and their families, ensuring access to clean water and sanitation facilities, and promoting economic opportunities in rural areas.

3. Enhancing Rural Healthcare Infrastructure: Bringing maternal and reproductive health services closer to rural populations is essential to reduce disparities in access. This can be achieved by investing in the development and improvement of healthcare facilities in rural areas, ensuring the availability of skilled healthcare providers, and providing transportation options for pregnant women to reach healthcare facilities. Telemedicine and mobile health initiatives can also be explored to provide remote access to healthcare services and information.

By implementing these recommendations, Sierra Leone can work towards reducing inequalities in access to maternal health services and improving overall maternal health outcomes.
AI Innovations Description
Based on the research findings, the following recommendation can be developed into an innovation to improve access to maternal health in Sierra Leone:

1. Strengthening Education: Investing in increasing the educational levels of women can have a significant impact on improving access to maternal health services. This can be achieved by implementing programs that focus on educating women about the importance of maternal health, reproductive rights, and family planning. Additionally, providing scholarships or incentives for girls to stay in school can help reduce disparities in education and empower women to make informed decisions about their health.

2. Improving Standard of Living: Addressing the socio-economic factors that contribute to inequality in accessing maternal health services is crucial. The government should focus on poverty alleviation programs, job creation, and income generation initiatives to improve the standard of living for vulnerable populations. This can include providing financial support for pregnant women and their families, ensuring access to clean water and sanitation facilities, and promoting economic opportunities in rural areas.

3. Enhancing Rural Healthcare Infrastructure: Bringing maternal and reproductive health services closer to rural populations is essential to reduce disparities in access. This can be achieved by investing in the development and improvement of healthcare facilities in rural areas, ensuring the availability of skilled healthcare providers, and providing transportation options for pregnant women to reach healthcare facilities. Telemedicine and mobile health initiatives can also be explored to provide remote access to healthcare services and information.

By implementing these recommendations, Sierra Leone can work towards reducing inequalities in access to maternal health services and improving overall maternal health outcomes.
AI Innovations Methodology
The methodology described in the abstract aims to simulate the impact of the main recommendations on improving access to maternal health in Sierra Leone. The study utilizes data from the Sierra Leone Demographic and Health Surveys conducted in 2008 and 2013. Five maternal and reproductive health indicators were selected for analysis: four or more antenatal care visits, skilled antenatal care provider, births delivered in a facility, births assisted by a skilled birth attendant, and any method of contraception.

To measure inequalities, the study adopts the Human Opportunity Index (HOI). The HOI allows for the measurement of differentials in access to maternal and reproductive health services over the two periods and decomposes it to determine the contribution of selected circumstance variables to inequality. The selected circumstance variables include household wealth status, maternal education, and place of residence.

The results of the study indicate that inequalities in access to maternal and reproductive health services have declined over time, as shown by the decrease in the dissimilarity index. This decrease in inequality is reflected in the increase in the HOI for all selected indicators. The study also identifies household wealth status, maternal education, and place of residence as the most important factors contributing to inequality in the use of maternal and reproductive health services.

In conclusion, the study highlights the need for the government to invest in increasing the educational levels of women, improving the standard of living, and bringing maternal and reproductive health services closer to rural populations in order to improve access to these services and reduce inequalities.

The findings of this study were published in the Journal of Public Health (United Kingdom) in 2020.

Statistics:
Citations: 5
Authors: 2
Identifiers:
DOI: 10.1093/pubmed/fdz023
ISSN: 17413842
Research Areas:
Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Sierra Leone
Study Design:
Cross Sectional Study
Participants Gender:
Female
Share this:
Facebook
Twitter
LinkedIn
WhatsApp
Email