Changes in the use of basic obstetric care in sub-Saharan Africa: evidence from demographic and health surveys using an Oaxaca-Blinder approach

---

Résumé

Background
The widespread mobilisation to improve maternal health over recent decades has led to increased prenatal consultations and assisted deliveries, resulting in a significant reduction in maternal mortality in many sub-Saharan African countries. This paper examines the progress made in basic obstetric care in four sub-Saharan African countries (Burkina Faso, Côte d’Ivoire, Ghana and Senegal), and investigates the sources of this progress to better inform future policy actions that will help achieve the Sustainable Development Goal 3 targets related to maternal and child health.

Methods
We used data from two Demographic and Health Surveys (DHSs) conducted in each of the four countries in the early 2010s and 2020s by their respective national statistical offices. Specifically, we relied on the 2010 and 2021 DHS for Burkina Faso, the 2011 and 2021 DHS for Côte d’Ivoire, the 2014 and 2022 DHS for Ghana and the 2010 and 2023 DHS for Senegal. We first estimated coverage rates for various components of maternity care using descriptive statistics with CIs to assess significant differences. Associations were examined using a multivariate decomposition analysis based on the Oaxaca-Blinder method adapted for binary outcomes.

Results
The results show a substantial increase in coverage of antenatal care (ANC) and postnatal care services over the past decade in all four countries. While progress in ANC4+ coverage is evident, the situation becomes more complex when considering more comprehensive quality indicators such as ANC8+ and its individual components. Decomposition results suggest that the factors driving progress are largely not fully captured by conventional socio-economic variables, pointing instead to changes in women’s health-seeking behaviour and broader improvements in health system performance.

Conclusion
This study highlights a marked gap between the high frequency of antenatal consultations and the quality of services delivered, particularly with respect to ANC8+ coverage and the full set of ANC components. Sustaining and deepening progress will require greater emphasis on improving service quality and expanding behaviour-change communication strategies tailored to local contexts, alongside continued health system strengthening.

Mots-clés

basic obstetric care, performance effect, composition effect, Sub-Saharan