Abstract
BackgroundBetween 1995 and 2014 Egypt successfully increased the use of regular antenatal care (URAC) among women from 30.4 to 82.9%. The same period saw a decrease in the wealth-based inequality in URAC. This paper investigates the changes in the main determinants contributing to the wealth-based inequality in URAC for the 2 years of 1995 and 2014, and the determinants that underlined the declines in this inequality.MethodsThe secondary analysis was based on data from the 1995 and 2014 rounds of the Egypt Demographic and Health Survey. Logistic regression was implemented to model URAC for the 2 years and inequality was measured using the concentration index. Decomposition of the concentration index and Blinder -Oaxaca decomposition were implemented to assess the contribution of the URAC determinants to its inequality and the changes between 1995 and 2014.ResultsDecomposition of inequalities in URAC in 1995 and 2014 showed that social determinants were the main contributors to these inequalities. More than 90% of the inequalities were explained by the living in rural Upper Egypt, women and their husbands secondary and higher education, the household standard of living, and birth order. These same determinants were responsible for more than 76% of the decline in the inequality in URAC between 1995 and 2014. Wide spread of poverty in rural Upper Egypt was found to contribute significantly to the inequality in URAC. Women and their husbands who have secondary or higher education maintained their high odds of URAC.ConclusionSince poverty in rural Upper Egypt, and inequality in education and parity are crucial social determinants of URAC inequality and its change overtime, new policies and interventions need to focus not only on the health system but on social initiatives with an equity lens to tackle the structural causes underlying these factors and their inequalities.
Highlights
Between 1995 and 2014 Egypt successfully increased the use of regular antenatal care (URAC) among women from 30.4 to 82.9%
This paper aims to investigate the changes in the main determinants contributing to the wealth-based inequality in URAC for the 2 years of 1995 and 2014, and the determinants that underlined the declines in this inequality
Wealth based inequality in the URAC has declined significantly between 1995 and 2014. This decline was associated with relative improvement in its social determinants inequalities
Summary
Between 1995 and 2014 Egypt successfully increased the use of regular antenatal care (URAC) among women from 30.4 to 82.9%. Campbell and colleagues attributed this success to the adoption of safe motherhood initiatives in Egypt [3] These initiatives were based on the results of the 1992 and 2000 national maternal mortality surveys, which revealed that one fifth of maternal deaths were attributed to avoidable risk factors [3]. All safe motherhood initiatives in Egypt incorporated activities to promote the use of antenatal care [3]. These initiatives paid back in an increased use of antenatal care services by pregnant women. While the absolute difference between the richest and the poorest wealth quintile was almost 61 percentage points in 1995 for both ever receiving antenatal care and for regular antenatal care, it decreased to 12.3 percentage points for ever receiving antenatal care and 21.1% for receiving regular antenatal care in 2014 [6, 7]
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