Analysing the sources of inequalities in access to essential medicines for pregnant women is a major concern for developing countries. These sources of unequal access are the result of the orientation of essential drug distribution towards the university-hospital model, which provides high-tech essential drugs that are far removed from the needs of a large proportion of the population in rural areas. However, economic efficiency in terms of distributing access to essential medicines to pregnant women depends on Sen's empowerment and allows for the promotion of development and escape from poverty. According to the World Health Organisation (WHO), approximately 830 women died every day due to complications related to access to essential medicines in 2015. As such, maternal health is one of the targets of the Millennium Development Goals.
The use of maternal health services is not only important for the survival and well-being of the woman, but also for that of her child. WHO recommends that if a woman has received one to four doses of tetanus toxoid-containing vaccine in the past, she should receive a new dose with each subsequent pregnancy up to a total of five doses (five doses protect for the entire childbearing period) and delivery should be attended by trained personnel. According to DHS (2018), 71% of women received the required doses of tetanus vaccine. From 2011 to 2018, the percentage of women who received the tetanus vaccine remained virtually unchanged (71–73%). The implementation of public health policies requires the identification of factors that influence access to health services. It can be seen that the level of access to essential medicines for women has decreased. Indeed, women's access to medicines is one of the four pillars of maternal mortality reduction. Only 67% of women had access to medicines, 45% in public pharmacies remain the most frequent and 33% in private (DHS, 2018). Most maternal deaths are preventable as the necessary medical interventions are well known. It is therefore crucial to improve women's access to essential medicines before, during and after childbirth.
The literature on inequalities in access to medicines in developing countries is almost non-existent. However, work on health care shows that inequalities in access can be identified through the effects of factors on these inequalities, including level of education, household wealth and place of residence (Allara and Fomba, 2020; Saleu, 2020; Bathily and Séné, 2021). These empirical studies establish a positive relationship between socio-economic status and access to health care. Indeed, an individual's socio-economic status can influence access to medicines in two ways. Depending on whether this position offers better living conditions to individuals or whether it favors the access of these individuals to essential medicines.
The literature also shows that factors such as: income, level of education of the head of household, women's place of residence and complementary health care are generally identified as sources of inequalities in access to health care services (Prusty et al., 2015; Abessolo and Mangoua, 2017; De La Torre et al., 2018; Nwosu and Ataguba, 2019; Ali and Chahan, 2020; Allara and Fomba, 2020; Saleu, 2020; Bathily and Séné, 2021). These studies suggest, for example, that women's education plays a very important role in the balance of power in the household; in decision making and resource allocation therefore modifies women's beliefs about the causes of illness and then influences the demand for modern health care. However, they note the existence of cultural and informational barriers that explain why poorer and less educated populations have a later recourse to health care and are more oriented towards curative care, due to a lesser knowledge of health care channels or a different relationship with the body and the disease (Couffinhal et al., 2005).
Education increases women's knowledge of modern health care facilities and also influences the importance she gives to the demand for modern health care services. Even a low level of education is beneficial to health (Cochrane et al., 1980). Education is associated with knowledge, imitation and the ability to manipulate the social environment. The more educated are more willing than the less educated to adopt innovative behaviours and to break away from traditional practices (Caldwell, 1979). Barrera (1990) finds that access to care benefits the children of educated women more than the children of less educated women. Education increases women's autonomy so that they develop a high level of confidence and ability to make decisions about their own health (Raghupathy, 1996). Educated women also seek the highest quality of service and have a high ability to use health care inputs to produce the best care. He argues that educated women are more informed about health problems, have more knowledge about the availability of health care services, and actually use this information more to maintain and achieve good household health status. In this sense, Stiglizt (2016) posits that, individuals' access to health increasingly depends on their parents' income, wealth and education. He goes on to say that, lack of health insurance is a contributing factor to poor health especially among the poor including the first quintile class. It itself contributes strongly to the explanation of inequalities of various kinds, including inequality of access to medicines. For the poor, in particular, infant and maternal mortality rates and the incidence of disease are on average higher than in other population groups (World Bank, 2002). The risk of being drawn into the vicious circle of poverty is greater because they are more prone to disease and have limited access to health services, including medicines. However, medicine is a key economic asset, the key to their survival. When a poor person falls ill or is injured, the whole family may be trapped in a vicious circle of impoverishment due to the high cost of medical care and limited access to social insurance schemes. Investing in women's education to improve their access to medicines is therefore an essential prerequisite for poverty reduction and an important vector for economic development.
The aim of this article is to identify the sources of inequalities in pregnant women's access to essential medicines in Cameroon. The contribution of this article lies in the consideration of inequalities in access to essential medicines for pregnant women, an aspect that has not yet been fully developed in the literature. This study has a double interest: firstly, it draws the attention of the scientific community to the extent of inequalities in access to essential medicines for pregnant women in Cameroon. Secondly, this study completes the literature on the sources of inequalities in women's access to essential medicines and the design of inclusive development programmes and policies.
The rest of the paper is structured as follows: section 2 presents the stylized facts on access inequalities, section 3 the methodology, section 4 presents and discusses the different results and section 5 concludes.