Trends of Maternal Health Service Coverage in the Democratic Republic of the Congo: A Pooled Cross-Sectional Study of MICS 2010 to 2018

Background: Maternal health service is essential for reducing maternal and newborn mortality. However, maternal health service status in the Democratic Republic of the Congo (DRC) remains poorly understood. This study aims to explore the trends of antenatal care (ANC) and skilled birth attendance coverage in the past decade in the DRC. Methods: The 13,313 participants were from two rounds of Multiple Indicators Cluster Survey (MICS) conducted by the National Institute of Statistics of the Ministry of Planning of the DRC, in collaboration with the United Nations Children’s Fund (UNICEF), in 2010 and 2017-2018. A regression-based method was adopted to calculate the adjusted coverages of ANC and skilled birth attendance. Subgroup analysis based on different socioeconomic status (SES) was conducted to explore the impact of domestic conflicts. Results: From 2010 to 2018, the overall weighted ANC coverage declined from 87.3% (95% CI 84.1% to 86.0%) to 82.4% (95% CI 81.1% to 84.0%), while the overall weighted skilled birth attendance coverage increased from 74.2% (95% CI 72.5% to 76.0%) to 85.2% (95% CI 84.1% to 86.0%) in the DRC. The adjusted ANC coverage and adjusted skilled birth attendance coverage both declined in the Kasai Oriental, but both increased in the Nord Kivu and Sud Kivu. In the Kasai region, the largest decline for the adjusted coverages of ANC and skilled birth attendance was found among the poorest women. Nevertheless, in the Kivu region, both the adjusted coverages of ANC and the skilled birth attendance increased for the poorest women. Conclusions: With lasting domestic conflicts, there was a systemic deterioration of maternal healthcare coverage in some regions, particularly among people with low SES. While in some other regions, maternal healthcare service was not severely disrupted due possibly to the substantial international health assistance.