5.2 Profile of Inequity in Maternal and Child Health Care Utilisation
5.2.1. Profile of Inequity in Maternal Health Care Utilisation
5.2.1.1 Profile of Inequity in Antenatal Care Utilisation
UNIVERSITY OF IBADAN LIBRARY
171
This section presents the results on horizontal inequity for antenatal care utilisation for the 1999, 2003, 2008, and 2013. The results are presented using the concentration curve and the horizontal inequity index. The concentration curve that is farthest from the line of equality gives a higher horizontal inequity index and indicates higher level of inequity. Positive value indicates pro-rich inequity in antenatal care utilisation.
Figure 5.1 presents the concentration curve and horizontal inequity index for the four periods considered in the analysis.
Horizontal inequity index = 0.373 for year 2013 Horizontal inequity index = 0.386 for year 2008
Horizontal inequity index = 0.327 for year 2003 Horizontal inequity index = 0.264 for year 1999
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.20 0.40 0.60 0.80 1.00
Cumulative % of antenatal care utilization
Cumulative % of respondents, ranked from poorest to richest
Line of equality
Number of antenatal visits during pregnancy
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.50 1.00
Cumulative % of antenatal cae utilisation
Cumulative % of population, ranked from poorest to richest
Line of equality
antenatal visits for pregnancy
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.50 1.00
Cumulative % of antenatal care uilisation
Cumulative % of population, ranked from poorest to richest
Line of equality
antenatal visits for pregnancy
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.50 1.00
Cumulative % of antenatal care utilisation
Cumulative % of population, ranked from poorest to richest
Line of equality
antenatal visits for pregnancy
UNIVERSITY OF IBADAN LIBRARY
172
Figure 5.1: Concentration curves and horizontal inequity index of antenatal care utilisation 1999-2013
As revealed by the values of the horizontal inequity index, the study found that inequity increased between 1999 and 2013 with an index of 0.264 in 1999 to 0.373 in 2013. There was a slight decrease in inequity from 0.386 to 0.373 from 2008 to 2013.
The study also considered the components that drove inequity in antenatal care utilisation; this is shown in Figure 5.2. Figure 5.2, which shows the components of the horizontal inequity index represented as the concentration index of each of the factor that contributes to inequity in antenatal health care utilisation.
UNIVERSITY OF IBADAN LIBRARY
173
Figure 5. 2 Standardised concentration index of need and non-need variables for antenatal care utilisation
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2013 2008 2003 1999
other non-need variables residence
region
partner's education woman's educatn wealth
need variables
UNIVERSITY OF IBADAN LIBRARY
174
The results show that wealth status, education of a woman and her partner's education accounted for more than 60% of about 80% of the factors driving inequity in Nigeria.
It is also important to note that need variables accounted for less than 2% of the factors driving inequity in antenatal care utilisation for the 4 periods under consideration.
Table 5.2 presents detailed information on the concentration index in Figure 5.2 and how the horizontal inequity index was derived given the concentration index for the need and non-need. The table shows the concentration index as the components of the need and the non-need variables, the inequality total as well as the horizontal inequity index discussed in Figure 5.1.
UNIVERSITY OF IBADAN LIBRARY
175
Table 5.2: Standardised Concentration Index for Antenatal care Utilisation NDHS
2013
NDHS 2008
NDHS 2003 NDHS 1999
Variable Index Index Index Index
NEED VARIABLES
currently pregnant 0.000<0.00 1
0.000<0.00 1
0.001 0.001
age of woman 0.002 0.000<0.00
1
0.000<0.001 0.000<0.001
Subtotal of need variables 0.002 0.000 0.002 0.001
NON-NEED /CONTROLLED VARIABLES
wealth index 0.124 0.131 0.120 0.080
woman's educational 0.073 0.035 0.045 0.048
Religion 0.000 0.007 0.014 0.016
Ethnicity 0.023 0.033
Insurance -0.001 -0.003
current marital status 0.000 0.000 -0.001
partner's education level 0.036 0.035 0.028 0.040
Employment status 0.004 0.039 0.002 0.020
UNIVERSITY OF IBADAN LIBRARY
176
Region 0.081 0.039 0.018 0.031
Residence 0.029 0.023 0.011 0.022
Subtotal of non-need variables 0.369 0.305 0.251 0.256
Residual error 0.004 0.081 0.077 0.256
Residual missing data -0.003 -0.004 -0.007 -0.001
Inequality total 0.371 0.382 0.322 0.264
Horizontal inequity index 0.373 0.386 0.327 0.264
5.2.1.2 Profile of inequity in skilled delivery care utilization
In this section, the results on the concentration curve and the horizontal inequity index are presented for skilled delivery utilisation for 1999, 2003, 2008, and 2013 in Figure 5.3.
UNIVERSITY OF IBADAN LIBRARY
177
Horizontal inequity index =0.481 for year 2013 Horizontal inequity index = 0.457 for year 2008
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.20 0.40 0.60 0.80 1.00
Cumulative % of skilled delivery utilization
Cumulative % of respondents ranked from poorest to richest
Line of equality
doctor nursemid wife amidwife
== 1
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.50 1.00
Cumulative % of skilled delivery utilization
Cumulative % of respondents ranked from poorest to richest
Line of equality
doctor nursemi dwife amidwif e == 1
UNIVERSITY OF IBADAN LIBRARY
178
Horizontal inequity index = 0.457 for year 2003 Horizontal inequity index = 0.320 for year 1999
Figure 5.3: Concentration curves and horizontal inequity index for skilled delivery Utilization 1999 to 2013
The results show that the concentration curves for skilled delivery lie below the line of equality with positive horizontal inequity index. This implies that there is pro-rich inequity in skilled delivery utilisation for the 4 periods under consideration. As revealed by the values of the horizontal inequity index, the results show that inequity increased between 1999 and 2013 from an index of 0.320 in 1999 to 0.481 in 2013 without a decrease at any point in time. Figure 5.4 reveals the components of the horizontal inequity index, the drivers of inequity in skilled delivery utilisation for each factor represented by the concentration index.
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.50 1.00
Cumulative % of skilled delivery
Cumulative % of respondents ranked from poorest to richest
Line of equality
doctor nursemi dwife amidwi fe == 1
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.50 1.00
Cumulative % of skilled delivery utilization
Cumulative % of respondents ranked from poorest to richest
Line of equalit y
doctor nursem idwife amidw ife ==
1
UNIVERSITY OF IBADAN LIBRARY
179
-20%
0%
20%
40%
60%
80%
100%
2013 2008 2003 1999
other non-need variables residence
region
partner's education woman's educatn wealth
need variables
UNIVERSITY OF IBADAN LIBRARY
180
Figure 5. 4 Standardised concentration index of skilled delivery utilisation for need and non-need variables
Just like antenatal care, wealth status, the woman and her partner's education accounted for 70% of 85% factors driving inequity in skilled delivery utilisation in Nigeria. Similarly, need variables accounted for less than 1% of the factors driving skilled delivery utilisation for all the four periods. Table 5.3 also shows detailed information on the components of the horizontal inequity index as concentration index for need and non-need variables.
UNIVERSITY OF IBADAN LIBRARY
181
Table 5.3: Standardized Concentration Index for Skilled Delivery Utilization NDHS 2013 NDHS 2008 NDHS 2003 NDHS
1999
Variable Index Index Index Index
NEED VARIABLES
currently pregnant 0.000<0.01 0.000<0.01 0.000<0.01 0.001
age of woman -0.015 -0.014 -0.002 -0.028
Subtotal of need variables -0.015 -0.014 -0.001 -0.027
NON-NEED VARIABLES
wealth index 0.118 0.124 0.091 0.053
Woman's educational 0.073 0.066 0.051 0.069
Religion 0.031 0.021 0.018 0.017
Ethnicity 0.010 0.020
Insurance 0.000 -0.001
current marital status -0.002 -0.001 0.001
UNIVERSITY OF IBADAN LIBRARY
182
partner's education level 0.026 0.010 0.014 0.009
Employment status 0.000 0.002 0.001 0.014
Region 0.012 0.016 0.002 0.021
Residence 0.012 0.020 0.013 0.005
Subtotal of non-need variables
0.303 0.277 0.170 0.189
Residual error 0178 0.180 0.268 0.131
Residual missing data -0.003 -0.004 -0.014 -0.010
Inequality total 0.463 0.440 0.424 0.283
Horizontal inequity index 0.481 0.457 0.438 0.320
Further, results on inequity on antenatal and skilled delivery can be compared. Both health care are inequitably utilised in favour of the rich, however, inequity in skilled delivery is greater than inequity in antenatal care going by the results for the values of
UNIVERSITY OF IBADAN LIBRARY
183
the horizontal inequity index. Figure 5.5 shows the concentration curves that compares inequity between skilled delivery and antenatal care.
UNIVERSITY OF IBADAN LIBRARY
184
NDHS 2013 NDHS 2008
NDHS 2003 NDHS 1999
Figure 5.5: Inequity in antenatal and skilled delivery utilisation 1999 to 2013 survey
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.50 1.00
Cumulative % of utilization variable
Cumulative % of respondents, ranked from poorest to richest
Line of equality
Number of antenatal visits during pregnancy doctor nursemidwi fe
amidwife
== 1
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.50 1.00
Cumulative % of utilization variable
Cumulative % of population, ranked from poorest to richest
Line of equality
antenat al visits for pregnan cydoctor
nursemi dwife amidwi fe == 1
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.20 0.40 0.60 0.80 1.00
Cumulative % of utilization variable
Cumulative % of population, ranked from poorest to richest
Line of equality
antenatal visits for pregnancy
doctor nursemid wife amidwife
== 1
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00
0.00 0.50 1.00
Cumulative % of utilization variable
Cumulative % of population, ranked from poorest to richest
Line of equality
antenatal visits for pregnancy
doctor nursemidw ife amidwife
== 1