Wealth-based equity in essential newborn care practices in Ethiopia: a cross-sectional study 

Abstract Background The World Health Organization has listed several newborn care practices as essential for health and survival. Reports from low-income countries, including Ethiopia, show inequities in practices but need more comprehensiveness. We aimed to analyze wealth-based equity of selected essential newborn care practices, i.e., skin-to-skin care, delayed bathing, proper cord care, and timely breastfeeding initiation among neonates born at health facilities and homes in Ethiopia. Methods The Performance Monitoring for Action Ethiopia 2019–2020 survey was conducted in five Ethiopian regions, representing 90% of the total population. We used data on 2,493 newborns. Wealth quintiles were based on principal component analysis of household assets. Wealth-based equity of selected essential newborn care practices was analyzed separately for facility and home deliveries using equiplot, equity gaps, equity ratios, and concentration indices. Results Overall, the equiplots for skin-to-skin care and delayed bathing practices showed minimal inequities for babies born in health facilities. When comparing the extreme groups, socio-economic differences were seen in delayed bathing and timely breastfeeding initiation. Using wealth as a continuous variable across all respondents, delayed bathing and proper cord care were more frequent in the better-off households. In home births, the equiplots showed that all selected essential newborn care practices were more common in the least poor groups. While comparing the extreme groups, socio-economic inequities were present in skin-to-skin care and delayed bathing practices. Using wealth as a continuous variable, skin-to-skin care and delayed bathing were more common in better-off households. Conclusion The coverage of selected essential newborn care practices was higher in facility deliveries. There were minimal socio-economic differences in newborn care of facility births, while inequities in skin-to-skin care and delayed bathing were prominent in home births. Initiatives should focus on increasing facility delivery and improving newborn care practices at home to ensure newborn care equity in Ethiopia.