Bad behaviour or “poor” behaviour?: Mechanisms underlying socio‐economic inequalities in maternal and child health‐seeking in Egypt

Background: Health-seeking behaviour is a key contributor to the widespread and unfair inequalities in health outcomes related to socio-economic position. This thesis compared the levels and determinants of maternal and child health-seeking between a national sample and the rural poor in Egypt, and examined whether existing inequalities could be explained by socio-cultural characteristics or ability to afford care. Methods: This quantitative analysis relied on two datasets: the Egypt Demographic and Health Survey from 2008 and a 2010/11 survey of households below the poverty line in rural Upper Egypt. Latent variables capturing several dimensions of socio-economic position were constructed and used in multivariable regression models to predict several dimensions of maternal (antenatal and delivery care) and child (diarrhoea and acute respiratory infection) health-seeking. Results: Latent constructs capturing socio-cultural and economic resources were identified in both datasets. Two further dimensions of socio-economic position in the Upper Egypt sample included dwelling quality and woman’s status. DHS analysis showed that sociocultural and economic capital were independently positively associated with seeking antenatal and delivery care among women, and with seeking timely and private child illness treatment. Free-of-charge public maternal care was not effectively targeted to poorest women. Poor households in Upper Egypt showed lower maternal healthseeking levels than nationally; both socio-cultural and economic resourcefulness positively predicted maternal health-seeking, dwelling quality was positively associated with private provider use, while women’s status was not associated with any dimension of maternal health-seeking behaviour. Conclusion: A better understanding of perceived and objective quality of care in both public and private sectors is required to reduce existing inequalities in the coverage of essential maternal and child health interventions. Improvement in free public care targeting is required to prevent catastrophically high expenditures for basic care among poor households.