Significant maternal and child deaths occur in sub-Saharan Africa (SSA) even with existing effective interventions. Antenatal care (ANC), for example, is an intervention that improves the health of pregnant women and their babies, but only 52% of pregnant women in SSA had the recommended minimum of four ANC visits between 2011 and 2016. While significant socioeconomic inequalities in ANC visits have been reported to the disadvantage of the poor, little is known about the depth of ANC coverage and associated inequalities. This paper introduces ‘deficits’ (i.e. the number of ANC visits that are needed to reach the recommended minimum of four ANC visits) and ‘surpluses’ (i.e. the number of ANC visits over and above the recommended minimum of four ANC visits) to assess socioeconomic inequalities in the indicator and depth of the ‘deficits’ and ‘surpluses’ in ANC visits. Using the latest available Demographic and Health Survey data for 36 SSA countries and concentration indices, the paper found that ‘deficits’ in ANC visits are more prevalent among poorer women compared to ‘surpluses’ that are concentrated among the rich. On average, women with ‘deficits’ in ANC visits require about two more ANC visits to reach the recommended four ANC visits, and women with ‘surpluses’ exceeded the recommended minimum by about two ANC visits. The factors that explain a substantial share of the socioeconomic inequalities in ANC ‘deficits’ and ‘surpluses’ in SSA include wealth, education and area of residency, which are essentially the social determinants of health inequalities. For policy response, it is suggested that education is a significant channel to affect the other social determinants of inequalities in ANC coverage reported in the paper. Thus, countries must prioritize quality education as addressing education, especially among women in SSA, will significantly reduce disparities in ANC service utilization and accelerate progress towards universal health coverage.

中文翻译：

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解释撒哈拉以南非洲 36 个国家在使用产前保健服务方面的社会经济差异和差距

即使现有有效的干预措施，撒哈拉以南非洲地区 (SSA) 仍会发生大量孕产妇和儿童死亡事件。例如，产前保健 (ANC) 是一种改善孕妇及其婴儿健康的干预措施，但 SSA 中只有 52% 的孕妇在 2011 年至 2016 年期间接受了建议的最少四次 ANC 就诊。据报道，非国大访问对穷人不利，对非国大覆盖的深度和相关的不平等知之甚少。本文介绍了“赤字”（即达到建议的最少四次 ANC 就诊所需的 ANC 就诊次数）和“盈余”（即 ANC 访问次数超过建议的最少四次 ANC 访问）以评估 ANC 访问中“赤字”和“盈余”的指标和深度方面的社会经济不平等。该论文使用 36 个 SSA 国家的最新人口和健康调查数据和集中指数，发现与集中在富人中的“盈余”相比，非国大就诊中的“赤字”在贫困女性中更为普遍。平均而言，在 ANC 就诊中存在“不足”的女性需要再进行大约两次 ANC 就诊才能达到建议的四次 ANC 就诊，而“过剩”的女性大约需要两次 ANC 就诊超过建议的最低限度。解释非国大“赤字”和“盈余”中很大一部分社会经济不平等的因素包括财富、教育和居住地区，这些本质上是健康不平等的社会决定因素。对于政策回应，建议教育是影响论文中报告的非国大覆盖范围内不平等的其他社会决定因素的重要渠道。因此，各国必须优先考虑优质教育，因为解决教育问题，尤其是在 SSA 中的女性，将显着减少 ANC 服务利用方面的差距，并加快实现全民健康覆盖的进程。