Social Gradient in Maternal Healthcare Utilization in Malawi: Analysis of Trends

Abstract

Despite the tremendous efforts to achieve universal health coverage in Malawi, progress has been trivial hitherto. This study uses logistic regression analysis in the context of Andersen’s behavioral model of healthcare utilization to investigate the determinants of antenatal care (ANC), skilled provider-assisted delivery, and facility-based delivery services among women aged 15–49 years in a resource-constrained country—Malawi. Our primary novelty lies in the construction of concentration indices and concentration curves to explore the drivers of socioeconomic inequalities in the context of Andersen’s model. Data from the Malawi Demographic and Health Survey 2004, 2010, and 2015 were used. Our results indicate that predisposing, enabling, and need factors have heterogeneous effects on the utilization of these services. While analysis of the inequalities generally reveals a downward trend, the poor–rich gap in ANC utilization remains exceptionally high. Moreover, decomposition analysis shows that the socioeconomic inequalities are almost exclusively driven by enabling factors, characterizing the observed inequalities as “inequities.”