Socioeconomic inequalities in institutional delivery in Ethiopia: a decomposition analysis of EDHS data (2011–2019)

Institutional delivery is a proven intervention to reduce maternal and early childhood mortality. Although maternal healthcare is the global and Ethiopian priority area, little has been investigated about the inequalities of the institutional delivery service utilization across socioeconomic groups. Therefore, this study aimed to assess socioeconomic inequality of institutional delivery using Ethiopian demographic and health surveys from 2011 to 2019 (EDHS2011-2019). We used the recent three consecutive, EDHS 2011, 2016, and 2019, datasets as a source of data to this study. Bivariable and multivariable logistic regression analysis were employed to assess the association of explanatory variables with the institutional delivery. The concentration index (CIX) was used to estimate socioeconomic inequality in institutional delivery. We used wealth index and mother’s education as socio-economic variables and concentration index was decomposed using Wagstaff approach to identify the contributing factors to overall estimated inequality. The CIX for wealth status was 0.35(95%CI: 0.33–0.37, P < 0.001) which revealed the significant disparity of institutional delivery across wealth categories. The rate of institutional delivery was 23.63% in Ethiopia. Place of residence (AOR: 3.80, CI: 2.78–5.18), mother’s education (AOR: 4.40, CI: 2.36–8.18), sex of household head (AOR: 1.44, CI: 1.07–1.94), wealth index (AOR: 4.80, CI: 2.61–8.86), distance of health facility (AOR: 1.74, CI: 1.40–2.16) and number of antenatal care visits (AOR: 2.88 CI: 2.31–3.58) were found to be significant factors for institutional delivery at P < 0.05. This study revealed there is socioeconomic disparity in institutional delivery in Ethiopia. The rate was lower than the national target and other study findings. Moreover, place of residence, mother’s education, sex of household head, distance to health facility, and number of antenatal care visits were significantly determining institutional delivery. Therefore, policymakers should bridge the gap by addressing inequalities and promoting equitable access to institutional delivery.