Abstract
BackgroundWealth disparities in levels of fertility are well documented in Egypt. Data from the Egypt Demographic and Health Survey (2014) showed that 61% of births to mothers from the poorest wealth quintile were of the third order or higher compared to 33% among mothers from the richest wealth quintile. The current paper investigates the main individual and socio-contextual level determinants of having more than two living children among women aged 30 and older, and decomposes its wealth-based inequality.MethodsThe secondary analysis was based on the 2014 Egypt Demographic and Health Survey. Multilevel linear regression was used to model the number of additional living children a woman has after her first two living children. A decomposition analysis of the wealth-based concentration index was applied using a multilevel model.ResultsIndividual level and area level attributes explained 83 and 17% of the variation in 3+ parity, respectively. Only areas not well served by the health system were significantly related to 3+ parity.Decomposition of the wealth-based concentration index revealed that 55.7 and 44.3% of the 3+ parity inequality were attributed to individual level attributes and area level attributes, respectively. At the individual level, early marriage accounted for 26% of the inequality in 3+ parity inequality. At the area level, living in areas not well served by the health system accounted for 22.3% of the 3+ parity wealth- based inequality, while highly gendered areas contributed 5.8% to this inequality. Areas’ random effects contributed 7.1% to the 3+ parity inequality, assist in identifying specific areas that require targeted policies.ConclusionMultilevel decomposition allowed the contributions of both the individual and area level attributes to be quantified. The decomposition highlighted the need for more tailored policies that target different social groups and different areas. Decomposition analysis also pinpointed specific areas that require additional targeted policies. This targeted approach can be used to support the efficient use of limited resources within any society.
Highlights
Wealth disparities in levels of fertility are well documented in Egypt
The current study proposes the use of a combination of multilevel analysis with decomposition analysis in the study of health inequality
Reliance on health modeling has proven inefficient in the identification of the main determinants of 3+ parity inequality
Summary
Wealth disparities in levels of fertility are well documented in Egypt. Data from the Egypt Demographic and Health Survey (2014) showed that 61% of births to mothers from the poorest wealth quintile were of the third order or higher compared to 33% among mothers from the richest wealth quintile. A few studies incorporated contextual effects in the decomposition analysis [5] These studies used dummy variables to represent the communities in which individuals live and implemented single-level health modeling. This simple approach to dealing with the socio-contextual factors misses the mark in identifying the main community level attributes that contribute to health inequality, as well as failing to take into consideration the clustering effect of the communities’ attributes on their members. The current study proposes the use of a combination of multilevel analysis with decomposition analysis in the study of health inequality This type of analysis can provide more insights about the accurate contribution of the social and structural factors inequalities and their translation into inequalities in the area level attributes that effect this health issue. The proper identification of these contributions can lead to efficient use of limited resources in tackling health inequalities
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