Socio-economic gradients in maternal health-seeking behaviours in Egypt

Lenka Benova, London School of Hygiene and Tropical Medicine (LSHTM)
Oona Campbell, London School of Hygiene and Tropical Medicine (LSHTM)
George B. Ploubidis, University of London

Background: Socio-economic inequalities in maternal health outcomes and coverage of essential interventions exist in most societies. In Egypt, their extent, determinants and consequences are poorly understood. We used data from the most recent Demographic and Health Survey (2008) to test the hypothesis that economic resources mediate the effect of socio-cultural capital on the progression of women through steps of health-seeking behaviour related to pregnancy and delivery care. Methodology: Factor analysis was used to capture two latent constructs of socio-economic position (SEP), individual socio-cultural and household-level economic capital. These two variables were entered into an adjusted mediation model, predicting progression through eight steps of maternal health-seeking behaviour. Results: Both individual and household-level SEP were directly and significantly associated with receiving any ANC and delivering in a health facility. The strongest direct effect of individual-level SEP was seen in models predicting the choice of private provider among ANC and delivery facility users. Models predicting the likelihood of obtaining free maternal services showed that free public ANC and delivery care was provided to women of lower mean household-level SEP. The costs of care reported by women differed depending on type of provider and care. A woman receiving minimum regular ANC care (four visits) and a c-section delivery would be expected to pay between 211 EGP (public care) and EGP 970 (private care) for the services. Conclusion: To our knowledge, this is the first analysis of socio-economic gradients in several consecutive maternal health-seeking behaviours in Egypt employing a formally specified mediation path analytic framework and adjusted for confounding. The results show that although Egypt accomplished commendable increases in the coverage of essential maternal health interventions in recent decades, cumulative socio-economic gradients in coverage of basic maternal health interventions remain.