Background: Addressing disparities in reproductive, maternal, newborn, and child health services is crucial in achieving the Sustainable Development Goal of universal health coverage. The persistence of social and geographic disparities in maternal health service coverage and utilization poses significant challenges. Ensuring equity in health service access and utilization as part of universal health coverage requires evidence whether these inequities exist. This study aimed to measure socio-economic and geographic equity in coverage and effective coverage of both antenatal care and skilled birth attendance.

Methods: We conducted a secondary analysis of data collected from the Performance Monitoring for Action Ethiopia from 2019 to 2020, including 2714 postpartum women at around six weeks and service delivery point assessment data from 462 health facilities. We measured inequities in the utilization of four or more antenatal care visits and skilled birth attendance using equiplots and concentration index. Moran's I, Getis-Ord Gi statistics and Kriging interpolations were employed to analyze geographic variations of maternal health service utilization.

Results: In this study, 40% (95%CI: 36, 45) utilized four or more ANC visits, and 12% (95%CI: 11, 14) received quality antenatal care. Over half (54%, 95%CI: 48, 59) of women utilized skilled birth attendance, but only 7% (95%CI: 4, 8) received quality delivery care. The absolute equity gap between the least poor and the poorest women was 43 percentage points for ANC visits and 65 percentage points for skilled birth attendance. A higher proportion of women in Central and Northern parts of Ethiopia had four or more ANC visits and utilized skilled birth attendance, while most parts of the Eastern part of the country and most areas in the South had low levels of utilization.

Conclusion: The coverage of four or more antenatal care visits and skilled birth attendance was low and inequitable, with the poorest women receiving fewer services. The coverage varied across different parts of the country. Interventions that target groups of women and geographic areas with low coverage of services are crucial for reaching the goal of universal health coverage.

Keywords: Inequity; Maternal health; Socio-economic status geographic difference.

© 2025. The Author(s).

背景： 解决生殖、孕产妇、新生儿和儿童医疗服务中的不平等是实现全民健康覆盖可持续发展目标的关键。社会和地理上的不平等持续存在，影响了孕产妇服务的覆盖面和利用情况，这给实现目标带来了重大挑战。为了确保作为全民健康覆盖一部分的卫生服务公平性，需要证据来证明这些不平等的存在。本研究旨在测量产前保健和熟练接生人员出勤在社会经济和地理上的公平性。

方法： 我们对2019年至2020年Performance Monitoring for Action Ethiopia收集的数据进行了二次分析，包括了产后六周左右的2714名妇女以及来自462个卫生设施的服务提供点评估数据。我们使用equiplots和集中指数测量四次或更多次产前保健访问及熟练接生人员出勤利用不平等的情况。Moran's I、Getis-Ord Gi统计量和Kriging插值被用于分析孕产妇服务利用率的地理变化。

结果： 在这项研究中，40%（95%CI: 36, 45）的妇女进行了四次或更多次产前保健访问，12%（95%CI: 11, 14）的妇女接受了高质量的产前护理。超过一半（54%，95%CI: 48, 59）的妇女使用了熟练接生人员服务，但只有7%（95%CI: 4, 8）的人获得了优质的分娩护理。最不贫困与最贫困的女性之间，在产前保健访问和熟练接生人员出勤利用方面存在43个百分点和65个百分点的绝对公平差距。埃塞俄比亚中部和北部地区的妇女四次或更多次产前保健访问率及熟练接生人员服务利用率较高，而该国东部大部分地区和南部大部分地区的这些指标较低。

结论： 四次或更多次的产前检查覆盖率和熟练接生人员出勤使用率低且不公平，最贫困妇女接受的服务较少。不同地区的服务覆盖面存在差异。针对服务覆盖不足的人群和地区进行干预对于实现全民健康覆盖的目标至关重要。

关键词： 不平等；孕产妇健康；社会经济地位和地理差异。