Social and geographical inequalities in prenatal care coverage in Colombia : A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)
Rodriguez-Lopez, Merida LU ; Botero Jaramillo, Daniela ; Prada, Sergio ; Merlo, Juan LU
and Leckie, George
LU
(2025)
In BMJ Global Health
10(8).
- Abstract
Background Access to adequate antenatal care (ANC) is crucial for improving maternal and neonatal health outcomes. Despite high national ANC coverage, Colombia still faces regional and socioeconomic disparities. This study aims to estimate geographical and intersectional inequalities in ANC coverage and evaluate the contribution of social determinants to these disparities. Methods We conducted a cross-sectional observational study using data from live birth certificates of singleton pregnancies in Colombia during 2022. Multilevel analysis of individual heterogeneity and discriminatory accuracy was performed using logistic regression models. Two approaches were applied: (1) geographical, with departments as the second level and (2)... (More)
Background Access to adequate antenatal care (ANC) is crucial for improving maternal and neonatal health outcomes. Despite high national ANC coverage, Colombia still faces regional and socioeconomic disparities. This study aims to estimate geographical and intersectional inequalities in ANC coverage and evaluate the contribution of social determinants to these disparities. Methods We conducted a cross-sectional observational study using data from live birth certificates of singleton pregnancies in Colombia during 2022. Multilevel analysis of individual heterogeneity and discriminatory accuracy was performed using logistic regression models. Two approaches were applied: (1) geographical, with departments as the second level and (2) intersectional, with strata as the second level, defined by the combination of health insurance, area of residency, ethnicity and maternal age. The variance partition coefficients (VPCs) from the random-intercept versions of the models were used as the disparity measure. Random slopes were included to allow for variations in the effects of ethnicity and insurance across departments. Results A total of 552 284 singleton pregnancies were analysed. National ANC coverage was 95.96%. However, 15 of the 33 departments and 24 of the 36 intersectional strata reported ANC coverage below the national average. For the geographical analysis, the VPC dropped from 24.45% to 10.02%, after accounting for population compositional effects. For the intersectional analysis, the VPC dropped from 39.43% to 3.64%, after adjusting for the additive effects of the individual characteristics used to define the strata. Ethnicity and health insurance were the most significant determinants of both geographical and intersectional heterogeneity. The effect of both factors varied significantly across departments. Conclusions Colombia faces significant geographical and intersectional inequalities, primarily driven by inequities in ethnicity and health insurance coverage. Policies targeting these social determinants are needed to ensure equitable access to maternal health services.
(Less)
- author
- Rodriguez-Lopez, Merida
LU
; Botero Jaramillo, Daniela
; Prada, Sergio
; Merlo, Juan
LU
and Leckie, George
LU
- organization
- publishing date
- 2025-08
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Epidemiology, Health services research, Maternal health, Public Health
- in
- BMJ Global Health
- volume
- 10
- issue
- 8
- article number
- e019608
- publisher
- BMJ Publishing Group
- external identifiers
-
- scopus:105013245882
- pmid:40813097
- ISSN
- 2059-7908
- DOI
- 10.1136/bmjgh-2025-019608
- language
- English
- LU publication?
- yes
- id
- 324cef01-7b92-4f2b-96aa-b4681d0f5742
- date added to LUP
- 2025-11-05 15:09:36
- date last changed
- 2025-12-03 17:35:45
@article{324cef01-7b92-4f2b-96aa-b4681d0f5742,
abstract = {{<p>Background Access to adequate antenatal care (ANC) is crucial for improving maternal and neonatal health outcomes. Despite high national ANC coverage, Colombia still faces regional and socioeconomic disparities. This study aims to estimate geographical and intersectional inequalities in ANC coverage and evaluate the contribution of social determinants to these disparities. Methods We conducted a cross-sectional observational study using data from live birth certificates of singleton pregnancies in Colombia during 2022. Multilevel analysis of individual heterogeneity and discriminatory accuracy was performed using logistic regression models. Two approaches were applied: (1) geographical, with departments as the second level and (2) intersectional, with strata as the second level, defined by the combination of health insurance, area of residency, ethnicity and maternal age. The variance partition coefficients (VPCs) from the random-intercept versions of the models were used as the disparity measure. Random slopes were included to allow for variations in the effects of ethnicity and insurance across departments. Results A total of 552 284 singleton pregnancies were analysed. National ANC coverage was 95.96%. However, 15 of the 33 departments and 24 of the 36 intersectional strata reported ANC coverage below the national average. For the geographical analysis, the VPC dropped from 24.45% to 10.02%, after accounting for population compositional effects. For the intersectional analysis, the VPC dropped from 39.43% to 3.64%, after adjusting for the additive effects of the individual characteristics used to define the strata. Ethnicity and health insurance were the most significant determinants of both geographical and intersectional heterogeneity. The effect of both factors varied significantly across departments. Conclusions Colombia faces significant geographical and intersectional inequalities, primarily driven by inequities in ethnicity and health insurance coverage. Policies targeting these social determinants are needed to ensure equitable access to maternal health services.</p>}},
author = {{Rodriguez-Lopez, Merida and Botero Jaramillo, Daniela and Prada, Sergio and Merlo, Juan and Leckie, George}},
issn = {{2059-7908}},
keywords = {{Epidemiology; Health services research; Maternal health; Public Health}},
language = {{eng}},
number = {{8}},
publisher = {{BMJ Publishing Group}},
series = {{BMJ Global Health}},
title = {{Social and geographical inequalities in prenatal care coverage in Colombia : A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)}},
url = {{http://dx.doi.org/10.1136/bmjgh-2025-019608}},
doi = {{10.1136/bmjgh-2025-019608}},
volume = {{10}},
year = {{2025}},
}