Introduction: Improving equity in access to services for the treatment of complications that arise during pregnancy
and childbirth, namely Emergency Obstetric Care (EmOC), is fundamental if maternal and neonatal mortality are to
be reduced. Consequently, there is a growing need to monitor equity in access to EmOC. The objective of this
study was to develop a simple questionnaire to measure equity in utilization of EmOC at Wolisso Hospital, Ethiopia
and compare the wealth status of EmOC users with women in the general population.
Methods: Women in the Ethiopia 2005 Demographic and Health Survey (DHS) constituted our reference
population. We cross-tabulated DHS wealth variables against wealth quintiles. Five variables that differentiated well
across quintiles were selected to create a questionnaire that was administered to women at discharge from the
maternity from January to August 2010. This was used to identify inequities in utilization of EmOC by comparison
with the reference population.
Results: 760 women were surveyed. An a posteriori comparison of these 2010 data to the 2011 DHS dataset,
indicated that women using EmOC were wealthier and more likely to be urban dwellers. On a scale from 0 (poorest)
to 15 (wealthiest), 31% of women in the 2011 DHS sample scored less than 1 compared with 0.7% in the study
population. 70% of women accessing EmOC belonged to the richest quintile with only 4% belonging to the poorest
two quintiles. Transportation costs seem to play an important role.
Conclusions: We found inequity in utilization of EmOC in favour of the wealthiest. Assessing and monitoring
equitable utilization of maternity services is feasible using this simple tool.