Inequality in opportunity of access to antenatal care in Cameroon: multilevel modelling, spatial analysis and decomposition methods

In Cameroon, major inequalities exist in women’s access to antenatal care (ANC), yet underlying circumstance drivers remain understudied. Using recently available Demographic and Health Survey data, we conducted multilevel model and spatial analyses to identify circumstance factors driving ANC disparities across the country's diverse regions. Drawing on a novel integration of theoretical frameworks, we evaluated how circumstances like geographic, economic and educational barriers combined to shape inequities. Both Shapley and Fields decomposition techniques apportioned contributors to ongoing inequality. Results from our study provide the first direct comparison of these approaches in Cameroon, finding a strong positive correlation between methods. Our findings show that ANC utilization overall was suboptimal, varying substantially between urban and rural areas. Key circumstance factors which disproportionately constrained disadvantaged groups’ opportunities for care included household wealth, level of education of the woman and spouse, and place of residence. Policy-relevant insights emerge from disentangling multifaceted opportunity gaps. Targeted interventions should address modifiable barriers facing underserved populations to promote more equal maternal health nationwide. Our multidisciplinary analytical approach offers lessons for analysing complex health disparities in diverse low-resource settings. Graphical abstract