Decomposing changes in child health inequality in Sub-Saharan Africa: new approach and new evidence

We analyze recent changes in child health inequality in 15 Sub-Saharan Africa (SSA) countries, characterize the features (observed and unobserved) contributing to these within-country changes, and investigate the existence of trade-offs between changes in child health inequality and changes in mean child health. We propose a methodology for estimating the contribution of a group of factors to the changes in child health inequality, which is perfectly comparable with existing decomposition approaches for mean child health. Among the observed features, we consider between-regional aspects (regional and rural/urban fixed effects) and within-regional factors including family background, mother’s demography, family structure and home infrastructures. Total child health inequality is falling in most countries, but the part of inequality explained by our set of observed features is increasing. While the unobserved and between-regional features have reduced child health inequality, the within-regional factors related to mother’s demography and family background have pushed inequality in the opposite direction. These two sets of features are precisely the ones behind the observed trade-off between child health inequality and mean child health: while their changes are harming child health inequality, they are benefiting mean child health.