Global Affairs Canada

Click to increase image sizeClick to decrease image size Acknowledgement On 1 June 2011 the University of Ottawa and the International Development Research Centre co-hosted a roundtable to discuss WDR 2011. The debate between the main panellists (John de Boer, Joseph Ingram, Nigel Roberts, Yiagadeesen Samy, Pamela Scholey and Christoph Zuercher) has greatly informed this review. Nonetheless, the author bears full responsibility for the analysis presented herein. Notes Les noms entiers de ces organisations sont l'Agence canadienne de développement international (ACDI), le Centre de recherches pour le développement international (CRDI), le Conseil canadien pour la coopération internationale (CCCI), l'Association québécoise des organismes de coopération internationale (AQOCI), et l'Association canadienne d'études du développement international (ACEDI). Les pays-membres du G-20 sont l'Argentine, l'Australie, le Brésil, le Canada, la Chine, la France, l'Allemagne, l'Inde, l'Indonésie, l'Italie, le Japon, le Mexique, la Russie, l'Arabie saoudite, l'Afrique du Sud, la Corée, la Turquie, le Royaume-Uni, les États-Unis et l'Union européenne.

1 At the core of policy debates on the state-level effects of transitional justice is a series of competing claims about the causal effects of various transitional justice mechanisms. A review of recent scholarship on transitional justice shows that empirical evidence of positive or negative effects is still insufficient to support strong claims. More systematic and comparative analysis of the transitional justice record is needed in order to move from ‘faith-based’ to ‘fact-based’ discussions of transitional justice impacts.

This paper examines an organizational pathology that we label “escalating indecision”—where people find themselves driven to invest time and energy in activities and decision processes aimed at resolving an issue of common concern, but where closure appears elusive. The phenomenon is illustrated through a case history in which a strategic orientation decision involving the configuration of a group of large teaching hospitals was continually made, unmade, and remade, producing little concrete strategic action over many years before achieving more tangible moves toward implementation. The paper introduces the notion of a “network of indecision” in which participants have become sufficiently attached to a common project to continue working together to move it forward, but their divergent conceptions of what this involves prevent them from materializing it in a tangible form. The paper suggests that networks of indecision are dialectically constituted through a set of practices of reification and practices of strategic ambiguity. The phenomenon is strongly associated with pluralistic settings characterized by diffuse power and divergent interests, and its prevalence is likely to be greater in situations of reactive leadership, uncertain resource availabilities, and long time horizons.

Cyber attackers rely on deception to exploit vulnerabilities and obfuscate their identity, which makes many pessimistic about cyber deterrence. The attribution problem appears to make retaliatory punishment, contrasted with defensive denial, particularly ineffective. Yet observable deterrence failures against targets of lower value tell us little about the ability to deter attacks against higher value targets, where defenders may be more willing and able to pay the costs of attribution and punishment. Counterintuitively, costs of attribution and response may decline with scale. Reliance on deception is a double-edged sword that provides some advantages to the attacker but undermines offensive coercion and creates risks for ambitious intruders. Many of the properties of cybersecurity assumed to be determined by technology, such as the advantage of offense over defense, the difficulty of attribution, and the inefficacy of deterrence, are in fact consequences of political factors like the value of the target and the scale-dependent costs of exploitation and retaliation. Assumptions about attribution can be incorporated into traditional international relations concepts of uncertainty and credibility, even as attribution involves uncertainty about the identity of the opponent, not just interests and capabilities. This article uses a formal model to explain why there are many low-value anonymous attacks but few high-value ones, showing how different assumptions about the scaling of exploitation and retaliation costs lead to different degrees of coverage and effectiveness for deterrence by denial and punishment. Deterrence works where it is needed most, yet it usually fails everywhere else.

BACKGROUND: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. METHODS: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). FINDINGS: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). INTERPRETATION: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

The World Health Organization (WHO) Framework Convention on Tobacco Control originated in 1993 with a decision by Ruth Roemer and Allyn Taylor to apply to tobacco control Taylor's idea that the WHO should utilize its constitutional authority to develop international conventions to advance global health. In 1995, Taylor and Ruth Roemer proposed various options to WHO, recommending the framework convention-protocol approach conceptualized by Taylor. Despite initial resistance by some WHO officials, this approach gained wide acceptance. In 1996, the World Health Assembly voted to proceed with its development. Negotiations by WHO member states led the World Health Assembly in May 2003 to adopt by consensus the WHO Framework Convention on Tobacco Control-the first international treaty adopted under WHO auspices. The treaty formally entered into force for state parties on February 27, 2005.

The novel SARS-CoV-2 coronavirus pandemic has emerged as a truly formidable threat to humankind's existence. In the wake of the massively volatile global situation created by COVID-19, it is vital to recognize that the trauma it causes can affect people in different ways, at the individual and collective levels, resulting in mental health challenges for many. Although mental health problems account for about one-third of the world's disability among adults, these issues tend to be under-addressed and overlooked in society and are closely associated with deadly disease outbreaks. In large scale outbreaks, the mental health problems experienced are not limited to infected persons but also extend to involve frontline health workers and community members alike. While it is crucial to limit the spread of infections during an outbreak, previous experience suggests that mental and behavioural health interventions should be fully included in public health response strategies.

BACKGROUND: The issue of child marriage is a form of human rights violation among young women mainly in resource-constrained countries. Over the past decades, child marriage has gained attention as a threat to women's health and autonomy. This study explores the prevalence of child marriage among women aged 20-24 years in sub-Saharan Africa countries and examines the association between child marriage and fertility outcomes. METHODS: Latest DHS data from 34 sub-Saharan African countries were used in this study. Sixty thousand two hundred and fifteen women aged 20-24 years were included from the surveys conducted 2008-2017. The outcome variables were childbirth within the first year of marriage (early fertility), first preceding birth interval less than 24 months (rapid repeat of childbirth), unintended pregnancy, lifetime pregnancy termination, the use of modern contraceptive methods, lifetime fertility and any childbirth. The main explanatory variable was child marriage (< 18 years) and the associations between child marriage and fertility outcomes were examined from the ever-married subsample to estimate odds ratios (ORs) and 95% CIs using binary logistic regression models. RESULTS: In the study population, the overall prevalence of women who experience child marriage was 54.0% while results showed large disparities across sub-Saharan African countries ranging from 16.5 to 81.7%. The prominent countries in child marriage were; Niger (81.7%), Chad (77.9%), Guinea (72.8%), Mali (69.0%) and Nigeria (64.0%). Furthermore, women who experience child marriage were 8.00 times as likely to have ≥3 number of children ever born (lifetime fertility), compared to women married at ≥18 years (OR = 8.00; 95%CI: 7.52, 8.46). Women who experience child marriage were 1.13 times as likely to use modern contraceptive methods, compared to adult marriage women (OR = 1.13; 95%CI: 1.09, 1.19). Those who married before the legal age were 1.27 times as likely to have lifetime terminated pregnancy, compared to women married at ≥18 years (OR = 1.27; 95%CI: 1.20, 1.34). Also women married at < 18 years were more likely to experience childbirth, compared to women married later (OR = 5.83; 95%CI: 5.45, 6.24). However, women married at < 18 years had a reduction in early childbirth and a rapid repeat of childbirth respectively. CONCLUSION: Implementing policies and programmmes against child marriage would help to prevent adverse outcomes among women in sub-Saharan Africa. Also, social change programmes on child-marriage would help to reduce child marriage, encourage the use of modern contraceptive, which would minimize lifetime terminated pregnancy and also children ever born.

OBJECTIVES: The aim of this study was to determine the association between women's decision-making power and utilisation of maternal healthcare services (MHS) among Bangladeshi women. SETTINGS: This is a nationally representative survey that encompassed Dhaka, Rajshahi, Rangpur, Chittagong, Khulna, Barisal and Sylhet in Bangladesh. Sample households were selected by a two-stage stratification technique. First, 207 clusters in urban areas and 393 in rural areas were selected for 600 enumeration areas with proportional probability. In the second stage, on average 30 households were selected systematically from the enumeration areas. Finally, 17 989 households were selected for the survey of which 96% were interviewed successfully. PARTICIPANTS: Cross-sectional data on 4309 non-pregnant women were collected from Bangladesh demographic and health survey 2014. Decision-making status on respondent's own healthcare, large household purchases, having a say on child's healthcare and visiting to family or relatives were included in the analysis. RESULTS: Prevalence of at least four antenatal attendance, facility delivery and postnatal check-up were respectively 32.6% (95% CI 31.2 to 34), 40.6% (95% CI 39.13 to 42.07) and 66.3% (95% CI 64.89 to 67.71). Compared with women who could make decisions alone, women in the urban areas who had to decide on their healthcare with husband/partner had 20% (95% CI 0.794 to 1.799) higher odds of attending at least four antenatal visits and those in rural areas had 35% (95% CI 0.464 to 0.897) lower odds of attending at least four antenatal visits. Women in urban and rural areas had respectively 43% (95% CI 0.941 to 2.169) and 28% (95% CI 0.928 to 1.751) higher odds of receiving postnatal check-up when their health decisions were made jointly with their husband/partner. CONCLUSION: Neither making decisions alone, nor deciding jointly with husband/partner was always positively associated with the utilisation of all three types of MHS. This study concludes that better spousal cooperation on household and health issues could lead to higher utilisation of MHS services.

Emerging Africa is a short glossy book written primarily to influence policy makers by showcasing the impressive accomplishments of 17 African countries over the past decade. Its author, Steven Radelet, is ideally placed to write this book, with an academic pedigree and experience in senior economic advisory positions in the US Treasury Department and the Office of the President of Liberia. He is currently senior adviser on development in the office of US Secretary of State Hillary Clinton. Radelet knows his audience (which typically favours the two-page briefing note format), and he demonstrates this with a simple and clear argument supported by striking graphs and compelling anecdotes. The book is the latest in a series of policy-oriented publications on economic development by Radelet, a senior fellow at the Center for Global Development from 2002 to 2010. It appears on the heels of other recent publications that are bullish on Africa's economic prospects. The set of reports on Africa published by McKinsey and Co. (a leading global consulting firm) in June 2010, and a similarly upbeat though less rigorous research note by the Boston Consulting Group, reinforce the optimism of Emerging Africa. The tone of the book also echoes that of the draft World Bank Africa Strategy, released for online consultation in November 2010.

The pricing accuracy and pricing performance of local volatility models depends on the absence of arbitrage in the implied volatility surface. An input implied volatility surface that is not arbitrage-free can result in negative transition probabilities and consequently mispricings and false greeks. We propose an approach for smoothing the implied volatility smile in an arbitrage-free way. The method is simple to implement, computationally cheap and builds on the well-founded theory of natural smoothing splines under suitable shape constraints.

Abstract Rationale Tezepelumab reduced exacerbations in patients with severe, uncontrolled asthma across a range of baseline blood eosinophil counts and fractional exhaled nitric oxide levels, and irrespective of allergy status, in the phase 2b PATHWAY (Study to Evaluate the Efficacy and Safety of MEDI9929 [AMG 157] in Adult Subjects With Inadequately Controlled, Severe Asthma; NCT 02054130) and phase 3 NAVIGATOR (Study to Evaluate Tezepelumab in Adults &amp; Adolescents With Severe Uncontrolled Asthma; NCT 03347279) trials. Objectives To examine the efficacy and safety of tezepelumab in additional clinically relevant subgroups using pooled data from PATHWAY and NAVIGATOR. Methods PATHWAY and NAVIGATOR were randomized, double-blind, placebo-controlled trials with similar designs. This pooled analysis included patients with severe, uncontrolled asthma (PATHWAY, 18–75 years old; NAVIGATOR, 12–80 years old) who received tezepelumab 210 mg or placebo subcutaneously every 4 weeks for 52 weeks. The annualized asthma exacerbation rate over 52 weeks and secondary outcomes were calculated in the overall population and in subgroups defined by inflammatory biomarker levels or clinical characteristics. Measurements and Main Results Overall, 1,334 patients were included (tezepelumab, n = 665; placebo, n = 669). Tezepelumab reduced the annualized asthma exacerbation rate versus placebo by 60% (rate ratio, 0.40 [95% confidence interval, 0.34–0.48]) in the overall population, and clinically meaningful reductions in exacerbations were observed in tezepelumab-treated patients with type 2–high and type 2–low disease by multiple definitions. Tezepelumab reduced exacerbation-related hospitalization or emergency department visits and improved secondary outcomes compared with placebo overall and across subgroups. The incidence of adverse events was similar between treatment groups. Conclusions Tezepelumab resulted in clinically meaningful reductions in exacerbations and improvements in other outcomes in patients with severe, uncontrolled asthma, across clinically relevant subgroups. Clinical trials registered with www.clinicaltrials.gov (NCT 02054130 [PATHWAY], NCT 03347279 [NAVIGATOR]).

Bottlenose dolphins are highly versatile breath-holding predators that have adapted to a wide range of foraging niches from rivers and coastal ecosystems to deep-water oceanic habitats. Considerable research has been done to understand how dolphins manage O2 during diving, but little information exists on other gases or how pressure affects gas exchange. Here we used a dynamic multi-compartment gas exchange model to estimate blood and tissue O2, CO2 and N2 from high-resolution dive records of two different common bottlenose dolphin (Tursiops truncatus) ecotypes inhabiting shallow (Sarasota Bay) and deep (Bermuda) habitats. The objective was to compare potential physiological strategies used by the two populations to manage shallow and deep diving life styles. We informed the model using species-specific parameters for blood hematocrit, resting metabolic rate, and lung compliance. The model suggests that the known O2 stores were sufficient for Sarasota Bay dolphins to remain within the calculated aerobic dive limit (cADL), but insufficient for Bermuda dolphins that regularly exceeded their cADL. By adjusting the model to reflect the body composition of deep diving Bermuda dolphins, with elevated muscle mass, muscle myoglobin concentration and blood volume, the cADL increased beyond the longest dive duration, thus reflecting the necessary physiological and morphological changes to maintain their deep-diving life-style. The results indicate that cardiac output had to remain elevated during surface intervals for both ecotypes, and suggests that cardiac output has to remain elevated during shallow dives in-between deep dives to allow sufficient restoration of O2 stores for Bermuda dolphins. Our integrated modelling approach contradicts predictions from simple models, emphasising the complex nature of physiological interactions between circulation, lung compression and gas exchange.

BACKGROUND: Understanding urban-rural gap in childhood survival is essential for health care interventions and to explain disparities in the determinants of Under-5 mortality. There is dearth of information about the factors explaining differentials in urban-rural Under-5 mortality especially in sub-Saharan Africa (SSA). In this study, we sought to quantify the contributions of bio-demographic, socioeconomic and proximate factors in explaining the urban-rural gap in Under-5 mortality in SSA. METHODS: This study utilized secondary data from Demographic and Health Survey (DHS) in 35 sub-Saharan countries conducted between 2006 and 2016. Child (aged 0 and 59 months) death was the outcome variable in this study. Oaxaca-Blinder decomposition was used to decipher urban-rural gap in the factors of Under-5 mortality. RESULTS: Significant urban-rural differentials were observed in Under-5 mortality across bio-demographic, socioeconomic and proximate factors. In the decomposition model, about 44.27% of urban group and 74.71% of rural group had Under-5 mortality in sub-Saharan countries. Maternal age, education, use of newspaper, TV, wealth index, total children ever born, size of baby and age at first birth contributed towards explaining urban-rural gap inUnder-5 mortality. CONCLUSION: These findings could be contributory to health care system improvement and socioeconomic developmental plans to address under-5 mortality in SSA. Strengthening maternal and child health (MCH) programmes, specifically in rural areas and improving health care services would help to ensure overall child survival.

Stéphane Lefebvre is a former Strategic Analyst at the Canadian Department of National Defence and a former Marcel Cadieux Policy Planning Fellow at the Canadian Department of Foreign Affairs and International Trade. The views expressed here are the author's and do not necessarily reflect the views of any governmental or nongovernmental organizations with which he is or has been affiliated. An earlier version of this article was presented at the Colloque Renseignement et Sécurité internationale, Laval University, Quebec City, Canada, on 20 March 2003.

This century is witnessing dramatic changes in the health needs of the world's populations. The double burden of infectious and chronic diseases constitutes major causes of morbidity and mortality. Over the last two decades, there has been a rise in infectious diseases, including the severe acute respiratory syndrome virus (SARS), the H1N1 pandemic influenza, the Ebolavirus and the Covid-19 virus. These diseases have rapidly spread across the world and have reminded us of the unprecedented connectivity that defines our modern civilization. Though some countries have made substantial progress toward improving global surveillance for emerging infectious diseases (EIDs), the vast majority of Low-and Middle-income Countries (LMICs) with fragile health systems and various system-related bottlenecks remain vulnerable to outbreaks and, as such, experience dramatic social and economic consequences when they are reported. Lessons learned from past outbreaks suggest that gender inequalities are common across a range of health issues relating to Sexual and Reproductive Health and Rights (SRHR), with women being particularly disadvantaged, partially due to the burden placed on them. Though these countries are striving to improve their health systems and be more inclusive to this vulnerable group, the national/ global outbreaks have burdened the overall system and thus paralyzed normal services dedicated to the delivery of Sexual and Reproductive Health (SRH) services. In this paper, we discuss the global commitments to SRH, the impact of the EIDs on the LMICs, the failure in the delivery of SRH services, and the strategies for successful implementation of recovery plans that must address the specific and differentiated needs of women and girls in resource-poor settings.

For years, mounting instability had led many to predict the imminent collapse of Yemen. These forecasts became reality in 2014 as the country spiralled into civil war. The conflict pits an alliance of the Houthis, a northern socio-political movement that had been fighting the central government since 2004, alongside troops loyal to a former president, Ali Abdullah Saleh, against supporters and allies of the government overthrown by the Houthis in early 2015. The war became regionalized in March 2015 when a Saudi Arabia-led coalition of ten mostly Arab states launched a campaign of air strikes against the Houthis. According to Saudi Arabia, the Houthis are an Iranian proxy; they therefore frame the war as an effort to counter Iranian influence. This article will argue, however, that the Houthis are not Iranian proxies; Tehran's influence in Yemen is marginal. Iran's support for the Houthis has increased in recent years, but it remains low and is far from enough to significantly impact the balance of internal forces in Yemen. Looking ahead, it is unlikely that Iran will emerge as an important player in Yemeni affairs. Iran's interests in Yemen are limited, while the constraints on its ability to project power in the country are unlikely to be lifted. Tehran saw with the rise of the Houthis a low cost opportunity to gain some leverage in Yemen. It is unwilling, however, to invest larger amounts of resources. There is, as a result, only limited potential for Iran to further penetrate Yemen.

AIM: The aim of the present study was to determine the barriers and motives influencing consumer reporting of adverse drug reactions (ADRs). METHODS: A systematic review, guided by the Cochrane Handbook, was conducted. Electronic searches included MEDLINE, EMBASE, PsycINFO, CINAHL, PubMed and the Cochrane Database of Systematic Reviews from 1964 to December 2014. Eligible studies addressed patients' perceptions and factors influencing ADR reporting. Studies about healthcare professional (HCP) reporting of ADRs were excluded. Studies were appraised for quality, and results were analysed descriptively. RESULTS: Of 1435 citations identified, 21 studies were eligible. Studies were primarily conducted in the UK, the Netherlands and Australia. The identified barriers to patient reporting of ADRs (n = 15 studies) included poor awareness, confusion about who should report the ADR, difficulties with reporting procedures, lack of feedback on submitted reports, mailing costs, ADRs resolved and prior negative reporting experiences. The identified motives for patients reporting ADRs (n = 10 studies) were: preventing others from having similar ADRs, wanting personal feedback, improving medication safety, informing regulatory agencies, improving HCP practices, responding to HCPs not reporting their ADRs and having been asked to report ADRs by HCPs. CONCLUSIONS: Most patients were not aware of reporting systems and others were confused about reporting. Patients were mainly motivated to make their ADRs known to prevent similar suffering in other patients. By increasing patient familiarity and providing clear reporting processes, reporting systems could better achieve patient reporting of ADRs.

BACKGROUND: Under-5 mortality rate in the sub-Saharan region has remained unabated. Worse still, information on the regional trend and associated determinants are not readily available. Knowledge of the trend and determinants of under-5 mortality are essential for effective design of intervention programmes that will enhance their survival. We aimed to examine the mortality patterns in under-5 children and maternal factors associated with under-5 deaths. METHODS: Demographic and Health Survey (DHS) data from five sub-Sahara Africa countries; Chad, Democratic Republic of Congo, Mali, Niger and Zimbabwe were used in this study. The sample size consisted of 68,085 women aged 15-49 years with at least one history of childbirth. The outcome variable was under-five mortality rate. Relevant information on maternal factors were extracted for analysis. Multivariable Cox proportional hazards regression was used to model maternal factors associated with under-five mortality. RESULTS: The current under-5 mortality rate (per 1,000 live births) was; 133 in Republic of Chad, 104 in Democratic Republic of Congo, 95 in Mali, 127 in Niger, and 69 in Zimbabwe. Several maternal and child level factors were found to be significantly associated with under-five mortality. Lack of spousal support (not currently married) resulted to increase in under-five mortality (Chad- Hazard Ratio [HR] = 1.11, 95%CI = 0.97-1.25; DR Congo- HR = 1.24, 95%CI = 1.11-1.40; Mali- HR = 2.43, 95%CI = 1.63-3.64; Niger- HR = 1.59, 95%CI = 1.24-2.03; Zimbabwe- HR = 1.33, 95%CI = 1.06-1.67). Delivery by caesarean section was significantly associated with under-five mortality (Chad- HR = 1.32, 95%CI = 1.00-1.77; DR Congo- HR = 1.20, 95%CI = 1.01-1.43; Mali- HR = 1.42, 95%CI = 1.08-1.85; Niger- HR = 1.43, 95%CI = 1.06-1.92; Zimbabwe- HR = 1.49, 95%CI = 1.03-2.15). CONCLUSION: Despite concerted effort by government and several stakeholders in health to improve childhood survival, the rate of under-5 mortality is still high. Our findings provided evidence on the contribution of maternal age, place of residence, household wealth index, level of education, employment, marital status, religious background, birth type, birth order and interval, sex and size of child, place and mode of delivery, to Under-5 mortality rate in SSA. The position of prominent risk factors for under-five mortality should be addressed through effective design of timely and efficient intervention aimed at reducing childhood mortality.

BACKGROUND: Ensuring equitable access to maternal health care including antenatal, delivery, postnatal services and fertility control methods, is one of the most critical challenges for public health sector. There are significant disparities in maternal health care indicators across many geographical locations, maternal, economic, socio-demographic factors in many countries in sub-Sahara Africa. In this study, we comparatively explored the utilization level of maternal health care, and examined disparities in the determinants of major maternal health outcomes. METHODS: This paper used data from two rounds of Benin Demographic and Health Survey (BDHS) to examine the utilization and disparities in factors of maternal health care indicators using logistic regression models. Participants were 17,794 and 16,599 women aged between15-49 years in 2006 and 2012 respectively. Women's characteristics were reported in percentage, mean and standard deviation. RESULTS: Mean (±SD) age of the participants was 29.0 (±9.0) in both surveys. The percentage of at least 4 ANC visits was approximately 61% without any change between the two rounds of surveys, facility based delivery was 93.5% in 2012, with 4.9% increase from 2006; postnatal care was currently 18.4% and contraceptive use was estimated below one-fifth. The results of multivariable logistic regression models showed disparities in maternal health care service utilization, including antenatal care, facility-based delivery, postnatal care and contraceptive use across selected maternal factors. The current BHDS showed age, region, religion were significantly associated with maternal health care services. Educated women, those from households of high wealth index and women currently working were more likely to utilize maternal health care services, compared to women with no formal education, from poorest households or not currently employed. Women who watch television (TV) were 1.31 (OR = 1.31; 95% CI = 1.13-1.52), 1.69 (OR = 1.69; 95% CI = 1.20-2.37) and 1.38 (OR = 1.38; 95% CI = 1.16-1.65) times as likely to utilize maternal health care services after adjusting for other covariates. CONCLUSION: The findings would guide stakeholders to address inequalities in maternal health care services. More so, health care programmes and policies should be strengthened to enhance accessibility as well as improve the utilization of maternal care services, especially for the disadvantaged, uneducated and those who live in hard-to-reach rural areas in Benin. The Benin government needs to create strategies that cover both the supply and demand side factors at attain the universal health coverage.