Reproductive and maternal health opportunities for women and girls are scarce in sub-Saharan Africa: the distribution of health care services is inequitable and 50% of women of child-bearing age have no access to basic services. Low coverage rates and unequal distribution mean that millions of women currently lack the most essential maternal and reproductive health services. This was one of the conclusions of the report presented by the Barcelona Institute for Global Health (ISGlobal) and the World Bank at a meeting of the board of the Partnership for Maternal, Newborn & Child Health (PMNCH) in the Mozambican city of Maputo on Wednesday 26 October.
The report, entitled Inequalities in Women’s and Girls’ Health Opportunities and Outcomes. A Report from Sub-Saharan Africa, presents the results and conclusions of a study of the most recent data from 29 sub-Saharan African countries. The analysis of the data for these countries, at national and regional levels, reveals that women of child-bearing age (15 to 49 years) have very unequal access to the 15 health opportunities studied.
“In the new development framework, that is, the Sustainable Development Goals (SDG), inequity—defined as unfair and avoidable inequalities—is a cross-cutting issue that underpins the whole agenda. Therefore, to make any progress we need a better understanding of the extent and causes of these inequalities”, explains Anna Lucas, coordinator of the ISGlobal Maternal, Child and Reproductive Health initiative.
“Using new metrics, such as the Human Opportunity Index (HOI), we can analyse this situation from a new perspective.” Clara Pons, lead author of the study, explains how the index works: “On the one hand, the HOI measures how many opportunities are available for a specific health service or indicator and how equitably they are distributed across different groups of women; and on the other it helps us to determine the main contributing factors for the inequalities identified.”
The study found the highest levels of inequity between different groups of women in the case of opportunities related to maternal health (especially childbirth attended by skilled personnel) and reproductive health (contraception). The chief causes of inequality were found to be wealth and related circumstances, such as education and place of residence. Poor women with low educational levels living in rural areas are the most excluded group.
The study also analysed the situation of adolescents (aged from 15 to 19 years), defining them as “a highly vulnerable subgroup with the worst results in terms of access to reproductive health services”. Among adolescent girls, the worst indicators and greatest inequalities were associated with marital status (being married); the next most influential factors were wealth and work status.
In a context in which large groups of women and children in sub-Saharan Africa are still excluded from major interventions, future progress will depend on the implementation of an approach focused on achieving universal access to essential services that targets the poorest groups of women from the outset. The report also provides additional evidence on the need for a multisectorial approach, given that the main causes of inequalities in maternal and reproductive health were found to be factors unrelated to the health system, such as poverty, educational level, and child marriage.