Explaining socioeconomic inequalities in completion of the maternal healthcare continuum in Tanzania: A Fairlie decomposition Analysis

Abstract Background Despite completion of the maternal healthcare continuum including antenatal care (ANC 4+), skilled birth attendance (SBA) and postnatal care (PNC) within 48 hours after delivery being linked to improving maternal and neonatal outcomes, there is limited information on what explains the disparities arising from completion of maternal healthcare continuum across socioeconomic groups. This study aimed to determine factors contributing to socioeconomic inequalities in completion in completion of the maternal healthcare continuum among women in Tanzania using Failie decomposition analysis. Methods We utilized data from the 2022 Tanzania Demographic and Health Survey (TDHS) where a total of 4,601 women aged 15–49 years who had a live birth within five years preceding the survey using Stata 17. Inequalities in completion of maternal healthcare continuum were assessed among rich and poor groups using concentration curves and concentration indices. Fairlie decomposition analysis was used to determine what explains the rich-poor gap in completion of maternal healthcare continuum among women. Results A total of 4,601 women were included in this analysis. Overall, completion of the maternal healthcare continuum was higher among rich women (47.0%) than poor women (25.0%), resulting in rich-poor gap of 21.95 percentage points. Likewise concentration curve of continuum completion plotted was lying well below the equality line indicating significant pro-rich inequality with concentration Index of 0.19, 95%CI [0.17–0.21], p-value < 0.001. The decomposition analysis revealed approximately 56.1% of the observed socioeconomic inequality was explained by differences in observed characteristics between groups. Education attainment accounted for the largest contribution to the explained inequality (49.0%), followed by parity (21.8%), residence (16.1%) and perceived distance to health facilities (11.1%). Maternal age contributed modestly (1.6%), while marital status, employment status and geographic zones showed negative contributions. Conclusion Significant rich-poor disparities in completion of the maternal healthcare in Tanzania were explained by differences in women’s characteristics with educational attainment emerging as the most important contributor. Improving educational opportunities and reducing barriers related to reproductive and healthcare access factors may contribute to narrowing the socioeconomic disparities in maternal healthcare utilization.