Ethno-political favoritism in maternal health care service delivery: Micro-level evidence from sub-Saharan Africa, 1981–2014

It is commonly held that political leaders favour people of the same ethnic origin. We test this argument of ethno-political favouritism by studying variations in the usage of maternal health care services across groups in sub-Saharan Africa (SSA). More specifically, we link geo-referenced individual-level data from the Demographic and Health Surveys on 601,311 births by 399,908 mothers in 31 countries during the period 1981–2014 with data on the settlement of ethnic groups and their political status. Our results indicate that women benefit from the shift that brings co-ethnics into power, increasing the probability of receiving maternal health care services. The effect strengthens with increased competitiveness around elections. We advance the current literature in four important ways. Firstly, we undertake the first analysis that utilizes shifts in ethno-political status for the same individual, effectively eliminating competing time-invariant explanations to that of shifts in ethno-political status. Secondly, since SSA governments often incorporate multiple groups, we test the effect of patronage on being co-ethnic with cabinet members in general, and not only the president. Thirdly, health services constitute the public good most desired by citizens of SSA. Our measure captures a vital health service that is highly desired across groups. An increase in usage likely reflects genuine trickle-down effects of having co-ethnics in power, a crucial ingredient in building popular support for ethnic patrons. Fourthly, we show that electoral competition is an important conditioner of ethno-political favouritism.