INEQUITIES IN SKILLED ATTENDANCE AT BIRTH IN MALAWI: A DECOMPOSITION ANALYSIS

Abstract

The study analyses wealth-related inequalities in child delivery by skilled health providers in Malawi and based on effects of the determinants of inequalities outlines some policy options. The study, particularly, hypothesizes that inequality in skilled attendance at birth cannot be explained by socio-demographic factors and there is no equity in delivery by skilled attendants. Secondary data from the (MDHS 2015) is used for the study. The data is analyzed using STATA 13 and the World Bank‟s ADePT software. The concentration index is used to measure inequalities in the use of skilled attendants preceded by the decomposition of the concentration index which is used to measure the contribution of each variable to inequalities in skilled attendance and finally the standardization of the concentration index, which is used to measure inequities in access to skilled attendants. The computed concentration index was positive, indicating that inequalities in use of delivery services by skilled providers favors women who are wealthier in Malawi. The presence of these inequalities is determined by residence, wealth and mothers education. The sex of household head, region and household size do not have a significant impact on inequalities. Furthermore, the indirect standardization used to measure horizontal inequity showed that the inequalities which exist are from non-need variables. Policy indications emerging from the study suggest that inequalities, albeit unsubstantial ones, exist. What this means is that, Malawi as a country, has certain policies that are working in as far as reducing inequalities are concerned and what remains is to identify the specific policies that are contributing to this and to ensure that all policies are geared towards the elimination of inequalities.