Decomposition of the wealth gradient in maternal healthcare quality in low- and middle-income countries

Although access to health services by poor populations has improved in most low- and middle-income countries, wealth remains associated with better quality of care that in turn leads to better health outcomes. Understanding the patterns of such inequities can inform the design of policies to improve services received by poor populations. We employ regression and inequality decomposition analyses using household survey data from 58 low- and middle-income countries between 2010 and 2021 to characterize inequity in quality of antenatal care, to test at which levels inequity exists, and to assess at which levels inequities are most pronounced. We find that in most countries and in both rural and urban areas, wealthier women are more likely to receive high-quality antenatal care than their poorer peers who reside in the same locality (village or neighborhood), even when attending similar types of health facilities (public vs. private, and primary care facilities vs. hospitals). However, although inequity exists at such a local level, most of the wealth gradient in quality of antenatal care is explained by variation in quality of care between wealthier and poorer localities.