Monitoring the decomposition of wealth-related inequality in the use of regular antenatal care in Egypt (1995-2014)

Background: Between 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, with significant decline in its prevalence among the richest and poorest wealth quintiles. This paper investigates the changes in the main determinants contributing to the wealth-based inequality in URAC for the two years of 1995 and 2014, and the determinants that underlined the declines in this inequality. Methods: The 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 those two 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. Results: Decomposition 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 determinants of living in rural Upper Egypt, women and their husbands having attained higher education, the household standard of living, and birth order. These same determinants were also responsible for more than 76% of the decline in the inequality in URAC between 1995 and 2014. Findings show that high concentration of poverty in rural Upper Egypt contributes significantly to the inequality in URAC. There was a relatively smaller change in the relationship between education and URAC, whereby women and their husbands who have secondary or higher education maintain their higher odds of URAC. These findings highlight the importance of the health system and the social determinants to achieve equality in URAC. Conclusion: Decomposition of inequality can support prioritization of interventions and can lead to effective and efficient use of the limited resources available in any society. Decomposition of the changes in inequality can aid the assessment of the effectiveness and the monitoring of the impact of these interventions and help identify new policies and interventions needed to tackle these inequalities.