Pro-poor Birth Coverage and Child Health in Africa

This paper explores which African countries had relatively low rates of underweight children and relatively high birth coverage (percentage of births with a skilled attendant) in the poorest quintile. Swaziland and Rwanda emerged as relatively ‘pro-poor’ in that both measures were more than one standard deviation better than predicted by GDP per capita. Unlike Swaziland, Rwanda’s status as an outlier was eliminated in regressions controlling also for urbanisation, medical professionals per 1000 people and health spending, suggesting that its pro-poor outcomes were related to these factors. AIDS funding may have helped Swaziland provide primary health care to the poor, but its high birth coverage preceded the HIV epidemic. Although relatively pro-poor in international terms, Swaziland and Rwanda emerged as relatively unequal by the CIX measure of health inequality with regard to percentage of underweight children across quintiles. It is important not to conflate relatively equal with relatively pro-poor health outcomes.