Contributors of inequalities in complete continuum of maternal healthcare service utilization in Tanzania: A multivariate 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 improved maternal and neonatal outcomes, completion of maternal healthcare continuum remain suboptimal and characterised by significant socioeconomic inequalities in Tanzania. This study aimed to determine factors contributing to socioeconomic disparities in completion of the maternal healthcare continuum among women in Tanzania using Failie decomposition analysis. Methods We utilized data from 2022 Tanzania Demographic and Health Survey (TDHS) to assess inequalities in completion of continuum of care. A total weighted sample of 4,601 women aged 15–49 years who had a live birth within five years preceding the survey were included in the analysis. Inequalities in completion of maternal healthcare continuum were assessed among rich and poor groups using concentration curves and concentration indices. A logit-based Fairlie decomposition analysis was used to determine what explains the rich-poor gap in completion of maternal healthcare continuum among women. Results Overall, there was (47.0%) completion of the maternal healthcare continuum among rich women compared to poor women (25.0%), with rich-poor gap of 21.95 percentage points. 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 Progress has been made in improving maternal and neonatal outcome in Tanzania. However, significant rich-poor disparities in completion of the maternal healthcare are still significant and explained by differences in women’s characteristics with education level 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.