1Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
4Department of Economics, Bu-Ali Sina University, Hamadan, Iran
5Department of Public Health, Qom University of Medical Sciences, Qom, Iran
6Centre for System Studies (CSS), Hull University Business School (HUBS), Hull York Medical School (HYMS), University of Hull, Hull, UK
Background Exploring changes in health inequality and its determinants over time is of policy interest. Accordingly, this study aimed to decompose inequality in neonatal mortality into its contributing factors and then explore changes from 1995-2000 to 2005-2010 in Iran.
Methods Required data were drawn from two Iran’s demographic and health survey (DHS) conducted in 2000 and 2010. Normalized concentration index (CI) was used to measure the magnitude of inequality in neonatal mortality. The contribution of various determinants to inequality was estimated by decomposing concentration indices in 1995-2000 and 2005-2010. Finally, changes in inequality were investigated using Oaxaca-type decomposition technique.
Results Pro-rich inequality in neonatal mortality was declined by 16%, ie, the normalized CI dropped from -0.1490 in 1995-2000 to -0.1254 in 2005-2010. The largest contribution to inequality was attributable to mother’s education (32%) and household’s economic status (49%) in 1995-2000 and 2005-2010, respectively. Changes in mother’s educational level (121%), use of skilled birth attendants (79%), mother’s age at the delivery time (25-34 years old) (54%) and using modern contraceptive (29%) were mainly accountable for the decrease in inequality in neonatal mortality.
Conclusion Policy actions on improving households’ economic status and maternal education, especially in rural areas, may have led to the reduction in neonatal mortality inequality in Iran.
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