title: Birth in a health facility--inequalities among the Ethiopian women: results from repeated national surveys.
abstract: BACKGROUND
  Uptake of health facilities for delivery care in Ethiopia has not been examined in the light of equality. We investigated differences in institutional deliveries by urbanity, administrative region, economic status and maternal education.
  
  
  METHODS
  This study was based on nation-wide repeated surveys undertaken in the years 2000, 2005, and 2011. The surveys used a cluster sampling design. Women of reproductive age were interviewed on the place of their last delivery. Data was analyzed using logistic regressions to estimate the weighted association between birth in a health facility and study's predictors.
  
  
  RESULTS
  Utilization of health institutions for deliveries has improved throughout the study period, however, rates remain low (5.4%,2000 and 11.8%,2011). Compared with women from rural places, women from urban areas had independent OR of a health facility delivery of 4.9 (95% CI: 3.4, 7.0), 5.0 (95% CI: 3.6, 6.9), and 4.6 (95% CI: 3.5, 6.0) in 2000, 2005, and 2011, respectively. Women with secondary/higher education had more deliveries in a healthcare facility than women with no education, and these gaps widened over the years (OR: 35.1, 45.0 and 53.6 in 2000, 2005, and 2011, respectively). Women of the upper economic quintile had 3.0-7.2 times the odds of healthcare facility deliveries, compared with the lowest quintile, with no clear trend over the years. While Addis-Ababa and Dire Dawa remained with the highest OR for deliveries in a health facility compared with Amhara, other regions displayed shifts in their relative ranking with Oromiya, SNNPR, Afar, Harari, and Somali getting relatively worse over time.
  
  
  CONCLUSIONS
  The disparity related to urbanity or education in the use of health facility for birth in Ethiopia is staggering. There is a small inequality between most regions except Addis Ababa/Dire Dawa and sign of abating inequity between economic strata except for the richest households.
authors.affiliation: Department of Health Services Management, Jimma University, Jimma, Ethiopia.
authors.forename: Elias Ali
authors.initials: EA
authors.lastname: Yesuf
authors.affiliation: Department of Health Services Management, Jimma University, Jimma, Ethiopia.
authors.forename: Mirkuzie Woldie
authors.initials: MW
authors.lastname: Kerie
authors.affiliation: Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Calderon-Margalit
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006268:Health Facilities / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016017:Odds Ratio; D036801:Parturition; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data
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