IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v19y2022i6p3566-d773310.html
   My bibliography  Save this article

Changes in Inequality in Use of Maternal Health Care Services: Evidence from Skilled Birth Attendance in Mauritania for the Period 2007–2015

Author

Listed:
  • Mohamed Vadel Taleb El Hassen

    (World Bank Group, Washington, DC 20433, USA)

  • Juan M. Cabases

    (Department of Economics, Public University of Navarra, 31006 Pamplona, Spain)

  • Moulay Driss Zine Eddine El Idrissi

    (World Bank Group, Washington, DC 20433, USA)

  • Samuel Mills

    (World Bank Group, Washington, DC 20433, USA)

Abstract

Skilled birth attendance is critical to reduce infant and maternal mortality. Health development plans and strategies, especially in developing countries, consider equity in access to maternal health care services as a priority. This study aimed to measure and analyze the inequality in the use of skilled birth attendance services in Mauritania. The study identifies the inequality determinants and explores its changes over the period 2007–2015. The concentration curve, concentration index, decomposition of the concentration index, and Oaxaca-type decomposition technique were performed to measure socioeconomically-based inequalities in skilled birth attendance services utilization, and to identify the contribution of different determinants to such inequality as well as the changes in inequality overtime using data from Mauritania Multiple Indicator Cluster Surveys (MICS) 2007 and 2015. The concentration index for skilled birth attendance services use dropped from 0.6324 ( p < 0.001) in 2007 to 0.5852 ( p < 0.001) in 2015. Prenatal care, household wealth level, and rural−urban residence contributed most to socioeconomic inequality. The concentration index decomposition and the Oaxaca-type decomposition revealed that changes in prenatal care and rural−urban residence contributed positively to lower inequality, but household economic status had an opposite contribution. Clearly, the pro-rich inequality in skilled birth attendance is high in Mauritania, despite a slight decrease during the study period. Policy actions on eliminating geographical and socioeconomic inequalities should target increased access to skilled birth attendance. Multisectoral policy action is needed to improve social determinants of health and to remove health system bottlenecks. This will include the socioeconomic empowerment of women and girls, while enhancing the availability and affordability of reproductive and maternal health commodities. This policy action can be achieved through improving the availability of obstetric service providers in rural areas; ensuring better distribution and quality of health infrastructure, particularly health posts and health centers; and, ensuring user fees removal for equitable, efficient, and sustainable financial protection in line with the universal health coverage objectives.

Suggested Citation

  • Mohamed Vadel Taleb El Hassen & Juan M. Cabases & Moulay Driss Zine Eddine El Idrissi & Samuel Mills, 2022. "Changes in Inequality in Use of Maternal Health Care Services: Evidence from Skilled Birth Attendance in Mauritania for the Period 2007–2015," IJERPH, MDPI, vol. 19(6), pages 1-17, March.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:6:p:3566-:d:773310
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/19/6/3566/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/19/6/3566/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. World Bank, 2016. "Islamic Republic of Mauritania Poverty Dynamics and Social Mobility 2008-2014," World Bank Publications - Reports 25848, The World Bank Group.
    2. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    3. Guido Erreygers & Tom Van Ourti, 2011. "Putting the cart before the horse. A comment on Wagstaff on inequality measurement in the presence of binary variables," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1161-1165, October.
    4. Mohamad A. Khaled & Paul Makdissi & Rami V. Tabri & Myra Yazbeck, 2018. "A framework for testing the equality between the health concentration curve and the 45‐degree line," Health Economics, John Wiley & Sons, Ltd., vol. 27(5), pages 887-896, May.
    5. Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432, April.
    6. Wagstaff, Adam, 2009. "Correcting the concentration index: A comment," Journal of Health Economics, Elsevier, vol. 28(2), pages 516-520, March.
    7. Erreygers, Guido & Van Ourti, Tom, 2011. "Measuring socioeconomic inequality in health, health care and health financing by means of rank-dependent indices: A recipe for good practice," Journal of Health Economics, Elsevier, vol. 30(4), pages 685-694, July.
    8. Peter Hangoma & Arild Aakvik & Bjarne Robberstad, 2017. "Explaining changes in child health inequality in the run up to the 2015 Millennium Development Goals (MDGs): The case of Zambia," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-21, February.
    9. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1991. "On the measurement of horizontal inequity in the delivery of health care," Journal of Health Economics, Elsevier, vol. 10(2), pages 169-205, July.
    10. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
    11. Rifkatu Nghargbu & Olanrewaju Olaniyan, 2017. "Inequity in Maternal and Child Health Care Utilization in Nigeria," African Development Review, African Development Bank, vol. 29(4), pages 630-647, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Mohammad Habibullah Pulok & Kees Gool & Mohammad Hajizadeh & Sara Allin & Jane Hall, 2020. "Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 171-180, March.
    2. Kjellsson, Gustav & Gerdtham, Ulf-G., 2013. "On correcting the concentration index for binary variables," Journal of Health Economics, Elsevier, vol. 32(3), pages 659-670.
    3. Olufunke Alaba & Lumbwe Chola, 2014. "Socioeconomic Inequalities in Adult Obesity Prevalence in South Africa: A Decomposition Analysis," IJERPH, MDPI, vol. 11(3), pages 1-20, March.
    4. John E. Ataguba, 2022. "A short note revisiting the concentration index: Does the normalization of the concentration index matter?," Health Economics, John Wiley & Sons, Ltd., vol. 31(7), pages 1506-1512, July.
    5. Carrieri, Vincenzo & Wuebker, Ansgar, 2013. "Assessing inequalities in preventive care use in Europe," Health Policy, Elsevier, vol. 113(3), pages 247-257.
    6. Carrieri, V. & Wuebker, A., 2012. "Assessing inequalities in preventive care use in Europe: A special case of health-care inequalities?," Health, Econometrics and Data Group (HEDG) Working Papers 12/25, HEDG, c/o Department of Economics, University of York.
    7. Merino Ventosa, María & Urbanos-Garrido, Rosa M.maria.merino.ven@gmail.com, 2016. "Disentangling effects of socioeconomic status on obesity: A cross-sectional study of the Spanish adult population," Economics & Human Biology, Elsevier, vol. 22(C), pages 216-224.
    8. FLEURBAEY, Marc & SCHOKKAERT, Erik, 2011. "Equity in health and health care," LIDAM Discussion Papers CORE 2011026, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    9. Peng Nie & Andrew E. Clarck & Conchita D'Ambrosio & Lanlin Ding, 2020. "Income-related health inequality in urban China (1991-2015): The role of homeownership and housing conditions," Working Papers 524, ECINEQ, Society for the Study of Economic Inequality.
    10. Laura Rossouw & Hana Ross, 2021. "Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries," IJERPH, MDPI, vol. 18(5), pages 1-14, March.
    11. Adam Wagstaff, 2011. "The concentration index of a binary outcome revisited," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1155-1160, October.
    12. Derek Asuman & Ama Pokuaa Fenny & Doreen Nyarko Anyamesem Odame, 2021. "Trends and antecedents of inequalities in maternal healthcare coverage in four African countries," Journal of International Development, John Wiley & Sons, Ltd., vol. 33(3), pages 515-544, April.
    13. Adam Wagstaff, 2011. "Reply to Guido Erreygers and Tom Van Ourti's comment on ‘The concentration index of a binary outcome revisited’," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1166-1168, October.
    14. Laura Vallejo‐Torres & Stephen Morris, 2013. "Income‐Related Inequity In Healthcare Utilisation Among Individuals With Cardiovascular Disease In England—Accounting For Vertical Inequity," Health Economics, John Wiley & Sons, Ltd., vol. 22(5), pages 533-553, May.
    15. Baeten, Steef & Van Ourti, Tom & van Doorslaer, Eddy, 2013. "Rising inequalities in income and health in China: Who is left behind?," Journal of Health Economics, Elsevier, vol. 32(6), pages 1214-1229.
    16. Kankeu, Hyacinthe Tchewonpi & Ventelou, Bruno, 2016. "Socioeconomic inequalities in informal payments for health care: An assessment of the ‘Robin Hood’ hypothesis in 33 African countries," Social Science & Medicine, Elsevier, vol. 151(C), pages 173-186.
    17. Kjellsson, Gustav, 2014. "Extending Decomposition Analysis to Account for Socioeconomic Background: Income-Related Smoking Inequality among Swedish Women," Working Papers 2014:29, Lund University, Department of Economics.
    18. Hai Zhong, 2010. "On decomposing the inequality and inequity change in health care utilization: change in means, or change in the distributions?," International Journal of Health Economics and Management, Springer, vol. 10(4), pages 369-386, December.
    19. Ziebarth, Nicolas R. & Frick, Joachim R., 2010. "Revisiting the Income-Health Nexus: The Importance of Choosing the," IZA Discussion Papers 4787, Institute of Labor Economics (IZA).
    20. Erreygers, Guido & Clarke, Philip & Van Ourti, Tom, 2012. "“Mirror, mirror, on the wall, who in this land is fairest of all?”—Distributional sensitivity in the measurement of socioeconomic inequality of health," Journal of Health Economics, Elsevier, vol. 31(1), pages 257-270.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:19:y:2022:i:6:p:3566-:d:773310. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.