Urban-rural disparities in receipt of treatment for obstetric complications in Ethiopia: A multivariate decomposition analysis

Background Reducing disparities in access to emergency obstetric care is crucial for decreasing maternal morbidity and mortality, particularly in low-resource settings where inequitable access remains a major challenge. While systematic monitoring and analysis of these disparities are essential for developing effective interventions, urban–rural disparities in Ethiopia remain understudied. Therefore, this study aimed to assess urban-rural disparities and identify factors contributing to disparities in treatment receipt for obstetric complications among postpartum women six weeks after childbirth in Ethiopia. Methods We analyzed nationally representative Performance Monitoring for Action (PMA) Ethiopia cohort data (2021–2023), including a weighted sample of 884 postpartum women who reported obstetric complications. Logit-based multivariate decomposition was used to quantify urban–rural disparities in the receipt of treatment and to identify contributing factors. Statistical significance was determined at p < 0.05, with 95% confidence intervals. Results In Ethiopia, 61.4% (95% CI: 54.7–68.1%) of women received treatment for obstetric birth complications. Urban women had a higher treatment rate (80.1%) than rural women (55.3%), showing a 24.6 percentage point difference, indicating a high level of inequality. The decomposition analysis showed that endowment effects explained 153% of the disparity, while coefficient effects contributed –53.4%, indicating that differences in characteristics drive the gap, whereas differences in how these characteristics translate into treatment partially offset it. Significant endowment components explaining the disparity included: the 35−49 age category (−7.5%), Muslim religion (4.8%), rich wealth status (75%), birth preparedness discussions during antenatal care (1.9%), and facility delivery (73%). For the coefficient components, the significant contributing factors were: ages 25−34 years (26%), ages 35−49 years (24.4%), and having four or more ANC visits (−28.4%). Conclusion Substantial urban-rural disparities in treatment receipt for obstetric complications exist in Ethiopia, driven by differences in both endowment and coefficient effect components. To address this gap, long-term strategies should address underlying socioeconomic disparities. In the short term, targeted interventions such as financial support for disadvantaged rural women, enhancing financial protection mechanisms, and improved maternal health services, particularly health facility delivery and birth preparedness initiatives, could narrow the disparity.