Inequality and inequity in maternal - children health care access in Argentina, Bolivia and Peru

Beijing

Congreso; 7th Congress iHEA; 2009

iHEA

Rationale: Among the main Millennium Development Goals are to improve maternal health and reduce infant mortality. Greater access to preventive health services in the most disadvantaged sectors from the socioeconomic and regional standpoint is key to accomplish such goals. It is recongnized that there are significant differences in the in access and utilization of health care services in the region, however, studies measuring and identifying the factors which determine inequity are relatively scarce and in some cases merely descriptive. Objectives: The objective of the paper is to measure inequality in preventive maternal - children health care access in Argentina, Bolivia and Peru in the beginning of the millenium and to identify the factors that contribute to inequality. Methodology: To measure inequalitiy in preventive maternal - children health care access Concentration Indices (CI) are computed for four dimensions: Antenatal control, Birth at a health care center, Iron supply during pregnancy and Child Immunization with data from Argentina, Bolivia and Peru. A dominance analysis is carried out. To explain health care access, probabilistic models are estimated including mother´s characteristics, belonging to an ethnic group, place of residence and a wealth index as explanatory variables. Then CIs are decomposed into the mentioned factors. To remove the correlation between wealth and the variables no amenable to policies CIs are directly standardized. Finally, results are analyzed in order to identify possible policy lines. Data are from Survey of Living Conditions, 2001 (Argentina), Demographic and Health National Survey, 2003 (Bolivia) and Demographic and Familiar Health Survey, 2004 (Peru) Results: The study shows the presence of a distribution regarding the utilization of maternal ? children services in favor of mothers who have a better socioeconomic condition in the analyzed countries. The results obtained indicate that the causes leading to inequality are wealth, higher education and living in urban areas, which enables to conclude that there is horizontal inequity, since when facing the same need, there is more use of preventive services during pregnancy generated by socioeconomic differences. In the case of Bolivia, the fact of belonging to an ethnic group contributes to increasing inequality in favor of those who do not belong to an ethnic group, although in considerably lower proportions than wealth and education level. In general, standardized indices assume a lower value however, the pro-rich bias is kept. Conclusions: Non-need variables are crucial in explaining inequality in maternal-children health care access in Argentina, Bolivia and Peru. The results suggest that development policies should be oriented toward improving wealth distribution and decreasing costs of access to health care services in order to ensure citizens the right to health.