The United Nations Millennium Development Goals have identified improving women’s access to
maternal health care as a key target in reducing maternal mortality in sub-Saharan Africa (sSA). Although
individual factors such as income and urban residence can affect maternal health care use, little is known
about national-level factors associated with use. Yet, such knowledge may highlight the importance of
global and national policies in improving use. This study examines the importance of national female
literacy on women’s maternal health care use in continental sSA. Data that come from the 2002e2003
World Health Survey. Multilevel logistic regression was used to examine the association between
national female literacy and individual’s non-use of maternal health care, while adjusting for individuallevel
factors and national economic development. Analyses also assessed effect modification of the
association between income and non-use by female literacy. Effect modification was evaluated with the
likelihood ratio test (G2
). We found that within countries, individual age, education, urban residence and
household income were associated with lack of maternal health care. National female literacy modified
the association of household income with lack of maternal health care use. The strength of the association
between income and lack of maternal health care was weaker in countries with higher female
literacy. We conclude therefore that higher national levels of female literacy may reduce income-related
inequalities in use through a range of possible mechanisms, including women’s increased labour
participation and higher status in society. National policies that are able to address female literacy and
women’s status in sub-Saharan Africa may help reduce income-related inequalities in maternal health
care use.