Wealth-based inequality in maternal continuum of care coverage among 15–24 aged women in Ethiopia using Wagstaff decomposition: EMDHS 2019

Abstract Background Despite the well-established benefits of the maternal continuum of care in reducing maternal and neonatal morbidity and mortality, coverage remains low in Ethiopia and continues to pose a significant public health challenge. Substantial disparities in maternal continuum of care coverage persist across socioeconomic groups. Evidence indicates that women from higher-income households are significantly more likely to utilize key maternal health services, including antenatal care, skilled birth attendance, and postnatal care, than women from lower-income households. These wealth-related inequalities contribute to persistently high maternal mortality rates, particularly among disadvantaged populations. Therefore, this study aimed to assess wealth-based inequalities in maternal continuum of care coverage among young women in Ethiopia. Methods This study used data from the 2019 Ethiopian Mini Demographic and Health Survey, a nationally representative cross-sectional survey conducted in Ethiopia. The analysis included a weighted sample of 996 women aged 15–24 years. Descriptive statistics were performed to summarize participants’ characteristics, and associations between maternal continuum of care coverage and explanatory variables were assessed using chi-square tests. Multicollinearity was evaluated using the variance inflation factor (VIF). Wealth-related inequalities in maternal continuum of care coverage were measured using the concentration index and visualized using concentration curves. The Wagstaff decomposition method was applied to quantify the contribution of individual factors to socioeconomic inequalities in maternal continuum of care coverage. Results The analysis revealed a substantial wealth -based gap in maternal Continuum of Care coverage in Ethiopia. Wealth-related inequalities were positive and statistically significant (Cnorm = 0388, p < 0.001), indicating that maternal Continuum of Care coverage was disproportionately concentrated among women from wealthier households. Further decomposition analysis showed that maternal age, wealth quintile, women’s education, religion, timing of antenatal care initiation, parity, mode of delivery, region, and place of residence significantly contributed to inequalities in maternal continuum of care coverage among young women in Ethiopia. Conclusions Maternal continuum of care utilization in Ethiopia was disproportionately concentrated among women with higher socioeconomic status, indicating persistent wealth-related inequalities. Women from poorer households, rural areas, and those with no formal education experienced substantially lower coverage across the continuum of care. These findings underscore the need for targeted interventions that address socioeconomic, educational, and geographic barriers to maternal healthcare utilization, with a particular focus on disadvantaged populations to promote equitable maternal health outcomes.