Socio-economic inequality in maternal health care utilization in Sub-Saharan Africa: Evidence from Togo.

Introduction: Despite improvements in health care in Togo, the maternal mortality rate remains high, and regional antenatal care and facility-based deliveries are limited. The aim of this study is to measure socioe-conomic inequality in maternal health care (MHC) utilization during pregnancy and delivery.

Method: The data were obtained from the last two rounds of the 1998 and 2013 Togo Demographic and Health Survey. Concentration index, concentration curve and logistic regression were used to measure and examine socio-economic inequality in antenatal care and facility-based deliveries.

Results: The concentration indices for antenatal visits and facility-based deliveries were 0.142 and 0.246 in 1998 and 0.129 and 0.159 in 2013, indicating inequality bias towards the rich in both. Household wealth status and women's education were the most significant contributors to inequality in antenatal visits and facility-based deliveries. In 2013, household economic status contributed approximately 75.66% of the inequality in facility-based deliveries, while mothers' education significantly contributed approximately 18.22% to the inequality in antennal visits. Additionally, universal health coverage should be considered as one of the main vehicles for reducing inequalities in the use of MHCs.

Conclusion: The results suggest that inequality in MHC utilization during pregnancy and delivery may be effectively reduced by improving the relevant strategies, in particular, those targeted at reducing poverty and illiteracy. School curricula need to be comprehensively addressed for ensuring essential sexual and reproductive education. Our results suggest that the use of MHC can be increased by broadening health insurance to include exemptions for poor and rural households.