Abstract / Summary
Armed conflict and economic instability can exacerbate socioeconomic inequalities in maternal and neonatal healthcare access and utilization. This study assessed the association between household income, healthcare costs, and maternal and neonatal healthcare utilization among women who had recently delivered and were reachable through functioning health facilities in Sudan. A facility-based cross-sectional study was conducted among 468 recently delivered women recruited from 19 public and private health facilities across nine Sudanese states. Data on socioeconomic characteristics, healthcare costs, maternal healthcare utilization, maternal and neonatal outcomes were collected using structured questionnaires. Associations were examined using Chi-square tests, Kruskal–Wallis tests, and Robust Poisson Regression analysis. Women from higher-income households had more antenatal care (ANC) visits than those from lower-income households (median: 6 vs. 3; P < 0.001). Adherence to the WHO-recommended ≥ 8 ANC contacts increased across income groups (29.2%, 12.8%, and 1.4%; P < 0.001), while postpartum care attendance was lower among lower-income women (69.0% vs. 88.2%; P < 0.001). In adjusted analysis monthly household income remained independently associated with ANC attendance (IRR = 1.30, 95% CI: 1.18–1.44; P < 0.001), while other Socio-demographic and financial factors didn’t significantly independently associated in the model. Among women who were able to access functioning health facilities in conflict-affected Sudan, socioeconomic disparities in maternal healthcare utilization persisted. Our findings suggest that conflict-related structural barriers may interact with household economic constraints, highlighting the need for integrated financial, transportation, and health-system interventions to improve equitable access to maternal healthcare.