Published in PLOS One on 2026-08-12, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Asebe Hagos, Melak Jejaw, Tesfahun Zemene Tafere, Kaleb Assegid Demissie, Misganaw Guadie Tiruneh, Getachew Teshale, Andualem Yalew Aschalew, Nebebe Demis Baykemagn, Jenberu Mekurianew Kelkay, Azmeraw Tadele
Source: PLOS One • DOI 10.1371/journal.pone.0355684
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Reducing disparities in access to emergency obstetric care is crucial for decreasing maternal morbidity and mortality, particularly in low-resource settings where inequitable access remains a major challenge. While systematic monitoring and analysis of these disparities are essential for developing effective interventions, urban–rural disparities in Ethiopia remain understudied. Therefore, this study aimed to assess urban-rural disparities and identify factors contributing to disparities in treatment receipt for obstetric complications among postpartum women six weeks after childbirth in Ethiopia.
We analyzed nationally representative Performance Monitoring for Action (PMA) Ethiopia cohort data (2021–2023), including a weighted sample of 884 postpartum women who reported obstetric complications. Logit-based multivariate decomposition was used to quantify urban–rural disparities in the receipt of treatment and to identify contributing factors. Statistical significance was determined at p < 0.05, with 95% confidence intervals.
In Ethiopia, 61.4% (95% CI: 54.7–68.1%) of women received treatment for obstetric birth complications. Urban women had a higher treatment rate (80.1%) than rural women (55.3%), showing a 24.6 percentage point difference, indicating a high level of inequality. The decomposition analysis showed that endowment effects explained 153% of the disparity, while coefficient effects contributed –53.4%, indicating that differences in characteristics drive the gap, whereas differences in how these characteristics translate into treatment partially offset it. Significant endowment components explaining the disparity included: the 35−49 age category (−7.5%), Muslim religion (4.8%), rich wealth status (75%), birth preparedness discussions during antenatal care (1.9%), and facility delivery (73%). For the coefficient components, the significant contributing factors were: ages 25−34 years (26%), ages 35−49 years (24.4%), and having four or more ANC visits (−28.4%).
Substantial urban-rural disparities in treatment receipt for obstetric complications exist in Ethiopia, driven by differences in both endowment and coefficient effect components. To address this gap, long-term strategies should address underlying socioeconomic disparities. In the short term, targeted interventions such as financial support for disadvantaged rural women, enhancing financial protection mechanisms, and improved maternal health services, particularly health facility delivery and birth preparedness initiatives, could narrow the disparity.
Introduction
Reducing maternal mortality remains a global priority under the Sustainable Development Goals (SDGs), with countries striving to significantly address maternal deaths by 2030. SDG 3 targets an ambitious target: lowering the global maternal mortality ratio (MMR) to fewer than 70 deaths per 100,000 live births [1]. Between 2000 and 2022, MMR globally declined by 34.3%. Despite this progress, approximately 810 women still die every day from pregnancy and childbirth-related complications [2]. The burden is disproportionately high in sub-Saharan Africa, accounting for 70% of these deaths, while Southern Asia accounts for about 16% [2,3].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Asebe Hagos, Melak Jejaw, Tesfahun Zemene Tafere, Kaleb Assegid Demissie, Misganaw Guadie Tiruneh, Getachew Teshale, Andualem Yalew Aschalew, Nebebe Demis Baykemagn, Jenberu Mekurianew Kelkay, Azmeraw Tadele. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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- Evidence brief: Integrated malaria service delivery and its determinants among pregnant women in Ethiopia: Multi level analysis of 2021/22 National Service Provision Assessment Survey
- Evidence brief: Family planning service receipt during facility visits in Ethiopia: Evidence from the 2021–2022 service provision assessment survey
- Evidence brief: Barriers to healthcare access among women in sub-Saharan Africa: A pooled analysis of multi-country DHS data (2019–2023)
