Exploring Socio-Economic Inequalities in Low Birth Weight: A Statistical Decomposition Approach.

BACKGROUND: Low birth weight is a critical predictor of child mortality and morbidity, contributing to both immediate health complications after birth and long-term health issues later in life. Globally, it remains a major public health challenge, particularly in low- and middle-income countries, where poor maternal nutrition, limited access to quality healthcare, and poverty exacerbate the risk. Regions such as Sub-Saharan Africa and South Asia carry the highest burden, accounting for the majority of low birth weight cases worldwide. Within this context, Pakistan stands out as one of the countries with the highest rates of child mortality and malnutrition, making the issue of low birth weight especially pressing.

METHODOLOGY: Utilizing the Demographic and Health Survey of 2017-18, multiple analytical techniques were used including logistic regression, standard, Wagestaff, Erreygers concentration index analysis and concentration curves.

RESULTS: The study indicates that low birth weight (LBW) is disproportionately concentrated among socio-economically disadvantaged groups. Negative and significant concentration indices for household wealth, maternal education, and paternal education show that children from poorer and less educated families are at higher risk of LBW. Further analysis reveals that the relationship between household wealth, parental education and LBW is nonlinear in the context of rural-urban division. Rural children from middle and higher-income families show a slightly elevated risk as compared with urban. Similarly, mother's education seems less effective against LBW. However, father's education might help as LBW is slightly reduced among higher educated fathers. This counterintuitive pattern may be influenced by factors such as multiple births, cesarean deliveries, antenatal care utilization, or other socio-cultural dynamics. For example rural women might have less decision-making autonomy regarding health and meeting other necessities of life.

CONCLUSION: The study finds that low birth weight (LBW) is disproportionately concentrated among socio-economically disadvantaged groups, with household wealth and parental education serving as strong protective factors. However children from middle and higher-income households, in rural areas, may also experience a slightly elevated risk of LBW as compared to urban populations Father's education might play a more protective role against low birth weight among rural areas.