The inequality of maternal health care in urban sub-Saharan Africa in the 1990s

Numerous studies document the disadvantage in child health of the urban poor in African cities. This study uses Demographic and Health Survey data from 23 countries in sub‐Saharan Africa to examine whether the urban poor experience comparable disadvantages in maternal health care. The results show that, although on average the urban poor receive better antenatal and delivery care than rural residents, the care of the urban poor is worse than that of the urban non‐poor. This suggests that the urban bias in the allocation of health services in Africa does not benefit the urban poor as much as the non‐poor. Multilevel analyses reveal significant variations in maternal health in urban areas across countries of sub‐Saharan Africa. The disadvantage of the urban poor is more pronounced in countries where maternal health care is relatively good. In these countries the urban poor tend to be even worse off than rural residents, suggesting that the urban poor have benefited least from improvements in maternal health care. © 2003 Population Investigation Committee