Abstract:
Background: The paper argues that unlike the income literature, the public health literature has not paid much
attention to the distribution of substantial improvements in health outcomes over the last decade or more,
especially, in the Sub-Saharan African (SSA) context. Thus, the paper examines current levels of utilisation, changes
in utilisation as well as inequality in utilisation of reproductive health services over the last 10 years in SSA.
Methods: The paper uses two rounds of Demographic and Health Survey (DHS) data from 30 SSA countries (latest
round) and 21 countries (earlier round) to compute simple frequencies, cross-tabulated frequencies and
concentration indices for health facility deliveries, skilled delivery assistance, 4+ antenatal visits and use of modern
contraceptives.
Results: The results confirm the fact that utilisation of the selected reproductive health services have improved
substantially over the last 10 year in several SSA countries. However, current levels of inequality in the use of
reproductive health services are high in many countries. Interestingly, Guinea’s pro-poor inequality in health facility
delivery and skilled attendance at birth changed to pro-rich inequality, with the reverse being true in the case of
use of modern contraceptives for Ghana, Malawi and Rawanda. The good news however is that in a lot of
countries, the use of reproductive health services has increased while inequality has decreased within the period
under study.
Conclusion: The paper argue that whiles income levels may play a key role in explaining the differences in
utilisation and the levels of inequality, indepth studies may be needed to explain the reason for differential
improvements and stagnation or deterioration in different countries. In this way, best practices from better
performing countries can be documented and adapted by poor performing countries to improve their situation.
