Inequality of Opportunity in Maternal Health Among Adolescent in Kenya

Abstract

Maternal health is both a public health and socio-economic burden. Adolescent mothers face higher maternal mortality and morbidity rates compared to older women in the reproductive age. Pregnancy complications are the second driving reason for deaths among 15-19-year-old adolescents globally. Stigma and discrimination are associated negatively with demand for maternal health care among adolescents and they often lead to societal rejection of teenage pregnancy contributing to more complications like suicide, mental illness, unsafe abortion and ultimately death. Like in many nations, the sustainable development goals (SDG) target 3.8 on achieving universal health coverage and SDG target 3.1.1 on maternal mortality ratio, has not yet been accomplished for the greater part of the health service. Kenya is determined at improving maternal health by decreasing inequalities in adolescent health care through creating access to the government funded maternity health services. However, access and utilization of this health services among adolescents is very low due to the inequalities that is beyond their control. Therefore, this study assessed the degree to which inequalities of opportunity are associated with access and utilisation of maternal health services among the adolescents. Three waves of pooled Kenya Demographic Health Survey (KDHS) data for 2003, 2008/09 and 2014 were used in the study. The study applied the Human Opportunity Index (HOI) methodology to estimate the coverage rate of this opportunities that is discounted as a result of the unequal allocations while the shapely decomposition was used to determine the contribution of each circumstance to the imbalances. The result coverage rate for ever pregnant, antenatal care, facility delivery and post-natal care among adolescents are 17.5%, 52.6.%, 70.6% and 59.8% respectively. The inequality measured by dissimilarity index (D) is lowest among adolescent facility delivery (11.1%) and highest among ever pregnant (20.24%). At the same time, opportunities for access to these maternal health opportunities also vary ranging from 14% for ever pregnant to only to 62.4% for facility delivery. Wealth Status, education and location were the major contributors to inequalities among this age group. These finding provides valuable evidence on inequalities of opportunities in maternal health to support legislation when developing policies to actualize compensatory measures planned to diminish opportunity gaps. There is also the need for equitable resource allocation for maternal health services among adolescents to ensure that such opportunities are not correlated with individual or society’s background. Moreover, there is need to have a multisectoral approach in addressing some of the imbalances that contribute to this inequality such as having socio-economic empowerment programs.