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Decomposition of the wealth gradient in maternal healthcare quality in low- and middle-income countries

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  • Shapira, Gil
  • Neelsen, Sven
  • Eozenou, Patrick Hoang-Vu

Abstract

Although access to health services by poor populations has improved in most low- and middle-income countries, wealth remains associated with better quality of care that in turn leads to better health outcomes. Understanding the patterns of such inequities can inform the design of policies to improve services received by poor populations. We employ regression and inequality decomposition analyses using household survey data from 58 low- and middle-income countries between 2010 and 2021 to characterize inequity in quality of antenatal care, to test at which levels inequity exists, and to assess at which levels inequities are most pronounced. We find that in most countries and in both rural and urban areas, wealthier women are more likely to receive high-quality antenatal care than their poorer peers who reside in the same locality (village or neighborhood), even when attending similar types of health facilities (public vs. private, and primary care facilities vs. hospitals). However, although inequity exists at such a local level, most of the wealth gradient in quality of antenatal care is explained by variation in quality of care between wealthier and poorer localities.

Suggested Citation

  • Shapira, Gil & Neelsen, Sven & Eozenou, Patrick Hoang-Vu, 2024. "Decomposition of the wealth gradient in maternal healthcare quality in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 359(C).
  • Handle: RePEc:eee:socmed:v:359:y:2024:i:c:s0277953624007275
    DOI: 10.1016/j.socscimed.2024.117273
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    References listed on IDEAS

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    1. Günther Fink & Eeshani Kandpal & Gil Shapira, 2022. "Inequality in the Quality of Health Services: Wealth, Content of Care, and the Price of Antenatal Consultations in the Democratic Republic of Congo," Economic Development and Cultural Change, University of Chicago Press, vol. 70(3), pages 1295-1336.
    2. Adam Wagstaff & Caryn Bredenkamp & Leander R. Buisman, 2014. "Progress on Global Health Goals: Are the Poor Being Left Behind?," The World Bank Research Observer, World Bank, vol. 29(2), pages 137-162.
    3. Rao, Krishna D. & Sheffel, Ashley, 2018. "Quality of clinical care and bypassing of primary health centers in India," Social Science & Medicine, Elsevier, vol. 207(C), pages 80-88.
    4. Guido Erreygers & Roselinde Kessels, 2017. "Socioeconomic Status and Health: A New Approach to the Measurement of Bivariate Inequality," IJERPH, MDPI, vol. 14(7), pages 1-23, June.
    5. Guido Erreygers & Roselinde Kessels & Linkun Chen & Philip Clarke, 2018. "Subgroup Decomposability of Income†Related Inequality of Health, with an Application to Australia," The Economic Record, The Economic Society of Australia, vol. 94(304), pages 39-50, March.
    6. Adjiwanou, Vissého & LeGrand, Thomas, 2013. "Does antenatal care matter in the use of skilled birth attendance in rural Africa: A multi-country analysis," Social Science & Medicine, Elsevier, vol. 86(C), pages 26-34.
    7. Jigyasa Sharma & Hannah H Leslie & Francis Kundu & Margaret E Kruk, 2017. "Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-14, January.
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