|Comparison of physical, public and human assets as determinants of socioeconomic inequalities in contraceptive use in Colombia - moving beyond the household wealth index|
||Catalina González, Tanja AJ Houweling, Michael G Marmot and Eric J Brunner
||International Journal for Equity in Health, 2010, 9:10, doi:10.1186/1475-9276-9-10
Background: Colombia is a lower-middle income country that faces the challenge of addressing health inequalities.
This effort includes the task of developing measures of socioeconomic position (SEP) to describe and analyse
disparities in health and health related outcomes. This study explores the use of a multidimensional approach to SEP, in
which socioeconomic inequalities in contraceptive use are investigated along multiple dimensions of SEP. We tested
the hypothesis that provision of Public capital compensated for low levels of Human capital.
Methods: This study used the 2005 Colombian Demographic and Health Survey (DHS) dataset. The outcome
measures were 'current non-use' and 'never use' of contraception. Inequalities in contraceptive behaviour along four
measures of SEP were compared: the Household wealth index (HWI), Physical capital (housing, consumer durables),
Public capital (publicly provided services) and Human capital (level of education). Principal component analysis was
applied to construct the HWI, Physical capital and Public capital measures. Logistic regression models were used to
estimate relative indices of inequality (RII) for each measure of SEP with both outcomes.
Results: Socio-economic inequalities among rural women tended to be larger than those among urban women, for all
measures of SEP and for both outcomes. In models mutually adjusted for Physical, Public and Human capital and age,
Physical capital identified stronger gradients in contraceptive behaviour in urban and rural areas (Current use of
contraception by Physical capital in urban areas RII 2.37 95% CI (1.99-2.83) and rural areas RII 3.70 (2.57-5.33)). The
impact of women's level of education on contraceptive behaviour was relatively weak in households with high Public
capital compared to households with low Public capital (Current use of contraception in rural areas, interaction p = <
0.001). Reduced educational inequalities attributable to Public capital were partly explained by differences in
household wealth but not at all by health insurance cover.
Conclusions: A multidimensional approach provides a framework for disentangling socioeconomic inequalities in
contraceptive behaviour. We provide evidence that material circumstances indexed by Physical capital are important
socioeconomic determinants while higher provision of Public capital may compensate for low levels of Human capital
with respect to modern contraceptive behaviour.