Living conditions and other factors in urban unplanned settlements present unique challenges for improving maternal and newborn health (MNH), yet MNH inequalities associated with such challenges are not well understood. This study examined trends and inequalities in coverage of MNH services in the last 20 years in unplanned and planned settlements of Lusaka City, Zambia. Geospatial information was used to map Lusaka’s settlements and health facilities. Zambia Demographic Health Surveys (ZDHS 2001, 2007, 2013/2014, and 2018) were used to compare antenatal care (ANC), institutional delivery, and Cesarean section (C-section) coverage, and neonatal mortality rates between the poorer 60% and richer 40% households. Health Management Information System (HMIS) data from 2018 to 2021 were used to compute service volumes and coverage rates for ANC1 and ANC4, and institutional delivery and C-sections by facility level and type in planned and unplanned settlements. Although the correlation is not exact, our data analysis showed close alignment; and thus, we opted to use the 60% poorer and 40% richer groups as a proxy for households in unplanned versus planned settlements. Unplanned settlements were serviced by primary centers or first-level hospitals. ZDHS findings show that by 2018, at least one ANC visit and institutional delivery became nearly universal throughout Lusaka, but early and four or more ANC visits, C-sections, and neonatal mortality rates remained worse among poorer than richer women in ZDHS. In HMIS, ANC and institutional delivery volumes were highest in public facilities, especially in unplanned settlements. The volume of C-sections was much greater within facilities in planned than unplanned settlements. Our study exposed persistent gaps in timing and use of ANC and emergency obstetric care between unplanned and planned communities. Closing such gaps requires strengthening outreach early and consistently in pregnancy and increasing emergency obstetric care capacities and referrals to improve access to important MNH services for women and newborns in Lusaka’s unplanned settlements.

城市无规划住区的生活条件和其他因素对改善孕产妇和新生儿健康 (MNH) 提出了独特的挑战，但与这些挑战相关的 MNH 不平等尚不清楚。本研究调查了过去 20 年来赞比亚卢萨卡市计划外和规划定居点 MNH 服务覆盖范围的趋势和不平等。地理空间信息被用来绘制卢萨卡的定居点和卫生设施的地图。赞比亚人口健康调查（ZDHS 2001、2007、2013/2014 和 2018）用于比较 60% 贫困人口和 60% 贫困人口之间的产前护理 (ANC)、机构分娩和剖腹产 (C-section) 覆盖率以及新生儿死亡率。较富裕的 40% 家庭。使用 2018 年至 2021 年的健康管理信息系统 (HMIS) 数据来计算 ANC1 和 ANC4 的服务量和覆盖率，以及按计划和计划外定居点的设施级别和类型划分的机构分娩和剖腹产。尽管相关性并不精确，但我们的数据分析显示出紧密的一致性；因此，我们选择使用 60% 的贫困群体和 40% 的富裕群体作为非规划定居点与规划定居点家庭的代表。计划外定居点由初级中心或一级医院提供服务。 ZDHS 的调查结果显示，到 2018 年，至少一次 ANC 就诊和机构分娩在整个卢萨卡几乎普及，但 ZDHS 的贫困妇女的早期和四次或以上 ANC 就诊、剖腹产和新生儿死亡率仍然比富裕妇女更差。在 HMIS 中，公共设施中的 ANC 和机构交付量最高，尤其是在计划外定居点。计划内设施内的剖腹产数量比计划外安置点内的剖腹产数量要多得多。我们的研究揭示了计划外和计划社区之间在 ANC 和紧急产科护理的时间和使用方面持续存在的差距。要缩小此类差距，需要在怀孕早期持续加强外展服务，提高紧急产科护理能力和转诊能力，以改善卢萨卡计划外定居点的妇女和新生儿获得重要的 MNH 服务的机会。