Family planning and maternal care services have become increasingly available in West Africa but the level of non-use remains high. This unfavorable outcome may be partly due to the unaffordability of reproductive health care services. Using the Demographic Health Survey data from Burkina Faso, Niger, Nigeria, Ghana, and Senegal, we perform a decomposition analysis to quantify the contribution of socio-demographic characteristics to disparities in exposure to mass media information on family planning, use of modern contraceptives, adequate antenatal care visits, facility-based childbirth and C-section between low-wealth and high-wealth women. Our study shows that differences in maternal characteristics between the wealth groups explain at least 40% of the gap in exposure to mass media family planning information, 30% in modern contraceptive use, 24% of adequate antenatal care visits, 47% of the difference in facility-based childbirths, and 62% in C-section. Lack of information on pregnancy complications, living in rural residence, religion, lack of autonomy in health facility seeking decision, need to pay, and distance explains the disparity in reproductive health care use across all countries. In countries with complete fee exemption policies for specific groups in the population, Ghana, Niger, and Senegal, the inequality gaps between wealth groups in having an adequate number of antenatal care visits and facility-based childbirth are smaller than in countries with partial or no exemption policies. But this is not the case for C-section. There is evidence that current policies addressing the cost of maternal care services may increase the wealth-based inequality in maternal care use if socio-demographic differences are not addressed. Public health interventions are needed to target socio-demographic disparities and health facility seeking problems that disadvantage women in poor households.

中文翻译：

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五个西非国家生殖保健使用不平等：基于财富的差距的分解分析。

西非越来越多地使用计划生育和产妇保健服务，但未使用的水平仍然很高。这种不利的结果可能部分是由于生殖保健服务负担不起。我们使用来自布基纳法索，尼日尔，尼日利亚，加纳和塞内加尔的“人口健康调查”数据，进行了分解分析，以量化社会人口学特征对大众传播有关计划生育，使用现代避孕药具的信息差异的贡献低收入和高收入妇女之间进行适当的产前检查，基于分娩的分娩和剖腹产。我们的研究表明，不同财富群体之间的孕产妇特征差异至少可以解释40％的大众媒体计划生育信息曝光率差距，30％的现代避孕方法使用率差距，进行适当的产前检查的比例为24％，以分娩方式分娩的差异为47％，剖腹产的比例为62％。缺乏有关妊娠并发症的信息，居住在农村的住所，宗教信仰，寻求决定的医疗机构缺乏自主权，需要付费以及距离遥遥，这说明了各国在生殖保健服务使用方面的差距。在对人口，加纳，尼日尔和塞内加尔的特定群体实行完全免税政策的国家中，拥有足够数量的产前保健探视和以设施为基础的分娩的财富群体之间的不平等差距要小于那些部分或完全没有的国家豁免政策。但这不是剖腹产的情况。有证据表明，如果不解决社会人口差异，目前解决孕产妇保健服务成本的政策可能会加剧基于财富的孕产妇保健不平等。需要采取公共卫生干预措施，以针对社会人口差异和保健设施，以解决使贫困家庭中的妇女处于不利地位的问题。