Residence-based inequalities in health facility delivery among women in sub-Saharan Africa

Background
Access to skilled healthcare during childbirth is essential, yet disparities persist, particularly in rural areas in sub-Saharan Africa. This study examines the factors associated with rural-urban disparities in health facility delivery in sub-Saharan Africa.

Methods
We utilised data from the Demographic and Health Surveys conducted in 23 sub-Saharan African countries from 2015 to 2022. We employed a multivariate non-linear decomposition model to examine the factors contributing to rural–urban disparities in health facility delivery. This method divides differences in mean values between two groups into components attributed to observed characteristics and their estimated effects using a regression model. Results were categorised into differences due to attributes and coefficients, with each group presenting coefficients, 95% confidence intervals, p-values and percentages.

Results
The decomposition analysis revealed that 87.13% of the observed rural-urban disparity in health facility delivery was explained by differences in women’s characteristics. The most significant contributors were in the richest wealth index (15.62%) and having four or more antenatal care visits (10.55%). Other notable factors included internet use (4.72%) and lack of formal education (4.43%).

Conclusions
This study identified significant rural–urban disparities in health facility delivery in sub-Saharan Africa, favouring urban areas. Key contributing factors included wealth status, antenatal care visits, internet use and educational attainment. Improving health facility delivery in rural areas requires enhancing women’s economic status, encouraging more antenatal care visits and prioritising interventions for women without formal education.