Equal access for all? Issues for people with HIV and with disabilities in Ethiopia

This paper challenges the assumption that once water and sanitation facilities are provided, everyone in the community has access to them. Drawing on detailed case studies from Ethiopia, the paper shows how two groups with critical needs for safe water and sanitation: those with HIV (PLWHA) and those with physical disabilities (PWDs), face severe access constraints. Findings revealed that both groups need more water, and need latrines more than others, yet their access to available facilities is restricted. PLWHA need more water and latrines due to vulnerability to and treatment of symptomatic infections, but face discrimination in access. PWDs need more water and latrines due to increased exposure to dirt from crawling, and increased vulnerability to the dangers of open defecation, but physical limitations and inappropriate designs limit their access. Since the underlying causes of their access constraints are different, separate programming and policy solutions are required for each group

Table_1_Extended Medicaid coverage will improve access but insufficient to enhance postpartum care utilization: a secondary analysis of the 2016–2019 Arizona Medicaid claims.DOCX

IntroductionPostpartum Medicaid eligibility extensions may increase access to healthcare for low-income women. However, its implications for healthcare utilization are unknown.MethodsWe analyzed the linked-infant birth certificate and claims data of women whose childbirths were paid for by Medicaid between 2016 and 2019 in Arizona, United States. We evaluated associations between postpartum care visits and Medicaid insurance type and assessed effect modification by the delivery route and type of residence.ResultsWomen with pregnancy-related Medicaid insurance were less likely to attend postpartum visits, with an adjusted odds ratio (aOR) of 0.70 and a 95% confidence interval (CI) of 0.66 to 0.74 than those with continuous Medicaid insurance. Younger age, rural residence [aOR 0.83, CI 0.78, 0.88], vaginal delivery route [aOR 0.11, CI 0.10, 0.12], and the absence of complications during/after childbirth [aOR 0.58, CI 0.49, 0.70] were associated with the absence of postpartum care visit. Low-income women who lost their pregnancy-related Medicaid coverage after 60 days in Arizona experienced lower rates of postpartum care utilization.DiscussionInterventions to improve postpartum utilization should be considered beyond extending postpartum Medicaid coverage for low-income women.</p