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Did Equity of Reproductive and Maternal Health Service Coverage Increase during the MDG Era? An Analysis of Trends and Determinants across 74 Low- and Middle-Income Countries.

Alkenbrack S, Chaitkin M, Zeng W, Couture T, Sharma S - PLoS ONE (2015)

Bottom Line: Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage.Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity.Equity in RH and MH service coverage has improved but varies considerably across countries and over time.

View Article: PubMed Central - PubMed

Affiliation: Health Policy Project, Center for Policy and Advocacy, Futures Group, Washington, DC, United States of America.

ABSTRACT

Introduction: Despite widespread gains toward the 5th Millennium Development Goal (MDG), pro-rich inequalities in reproductive health (RH) and maternal health (MH) are pervasive throughout the world. As countries enter the post-MDG era and strive toward UHC, it will be important to monitor the extent to which countries are achieving equity of RH and MH service coverage. This study explores how equity of service coverage differs across countries, and explores what policy factors are associated with a country's progress, or lack thereof, toward more equitable RH and MH service coverage.

Methods: We used RH and MH service coverage data from Demographic and Health Surveys (DHS) for 74 countries to examine trends in equity between countries and over time from 1990 to 2014. We examined trends in both relative and absolute equity, and measured relative equity using a concentration index of coverage data grouped by wealth quintile. Through multivariate analysis we examined the relative importance of policy factors, such as political commitment to health, governance, and the level of prepayment, in determining countries' progress toward greater equity in RH and MH service coverage.

Results: Relative equity for the coverage of RH and MH services has continually increased across all countries over the past quarter century; however, inequities in coverage persist, in some countries more than others. Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage. Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity.

Conclusion: Equity in RH and MH service coverage has improved but varies considerably across countries and over time. Even among the subset of countries that are close to achieving the MDGs, progress made on equity varies considerably across countries. Enduring disparities in access and outcomes underpin mounting support for targeted reforms within the broader context of universal health coverage (UHC).

No MeSH data available.


Distribution of facility delivery coverage in India, by wealth quintile, 1993–2006.Q1-5 = wealth quintiles from poorest to wealthiest households. CI = concentration index.
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pone.0134905.g010: Distribution of facility delivery coverage in India, by wealth quintile, 1993–2006.Q1-5 = wealth quintiles from poorest to wealthiest households. CI = concentration index.

Mentions: By the last time period, the equity gap in South and East Asian countries had narrowed, particularly for demand met for family planning (Fig 7). Despite progress, inequities in use of facility delivery are still widespread in the region, especially in Timor-Leste, Bangladesh and Nepal (Fig 8). The most noteworthy inconsistency across indicators is Bangladesh, which registered the highest equity for CPR and family planning demand met, but the lowest for facility delivery, despite improvements made on this indicator. Indicators for CPR and facility delivery by wealth quintiles in Bangladesh are shown in Fig 9. India has not had a survey in recent years, but in 2005–06 inequities were still relatively high, particularly for facility delivery. In fact, Fig 10 shows that use of facility delivery in India is still relatively inequitable across socioeconomic groups (CI = 0.33 in 2005–06). Similarly, inequities in the Philippines are still high for facility delivery. Meanwhile, of the countries studied, Pakistan experienced the largest improvement for three of the four services (CPR, demand met, and ANC) (Fig 11). However, much of this improvement in absolute equity is due to the fact that use of facility delivery among the poor was almost non-existent in 1991.


Did Equity of Reproductive and Maternal Health Service Coverage Increase during the MDG Era? An Analysis of Trends and Determinants across 74 Low- and Middle-Income Countries.

Alkenbrack S, Chaitkin M, Zeng W, Couture T, Sharma S - PLoS ONE (2015)

Distribution of facility delivery coverage in India, by wealth quintile, 1993–2006.Q1-5 = wealth quintiles from poorest to wealthiest households. CI = concentration index.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4558013&req=5

pone.0134905.g010: Distribution of facility delivery coverage in India, by wealth quintile, 1993–2006.Q1-5 = wealth quintiles from poorest to wealthiest households. CI = concentration index.
Mentions: By the last time period, the equity gap in South and East Asian countries had narrowed, particularly for demand met for family planning (Fig 7). Despite progress, inequities in use of facility delivery are still widespread in the region, especially in Timor-Leste, Bangladesh and Nepal (Fig 8). The most noteworthy inconsistency across indicators is Bangladesh, which registered the highest equity for CPR and family planning demand met, but the lowest for facility delivery, despite improvements made on this indicator. Indicators for CPR and facility delivery by wealth quintiles in Bangladesh are shown in Fig 9. India has not had a survey in recent years, but in 2005–06 inequities were still relatively high, particularly for facility delivery. In fact, Fig 10 shows that use of facility delivery in India is still relatively inequitable across socioeconomic groups (CI = 0.33 in 2005–06). Similarly, inequities in the Philippines are still high for facility delivery. Meanwhile, of the countries studied, Pakistan experienced the largest improvement for three of the four services (CPR, demand met, and ANC) (Fig 11). However, much of this improvement in absolute equity is due to the fact that use of facility delivery among the poor was almost non-existent in 1991.

Bottom Line: Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage.Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity.Equity in RH and MH service coverage has improved but varies considerably across countries and over time.

View Article: PubMed Central - PubMed

Affiliation: Health Policy Project, Center for Policy and Advocacy, Futures Group, Washington, DC, United States of America.

ABSTRACT

Introduction: Despite widespread gains toward the 5th Millennium Development Goal (MDG), pro-rich inequalities in reproductive health (RH) and maternal health (MH) are pervasive throughout the world. As countries enter the post-MDG era and strive toward UHC, it will be important to monitor the extent to which countries are achieving equity of RH and MH service coverage. This study explores how equity of service coverage differs across countries, and explores what policy factors are associated with a country's progress, or lack thereof, toward more equitable RH and MH service coverage.

Methods: We used RH and MH service coverage data from Demographic and Health Surveys (DHS) for 74 countries to examine trends in equity between countries and over time from 1990 to 2014. We examined trends in both relative and absolute equity, and measured relative equity using a concentration index of coverage data grouped by wealth quintile. Through multivariate analysis we examined the relative importance of policy factors, such as political commitment to health, governance, and the level of prepayment, in determining countries' progress toward greater equity in RH and MH service coverage.

Results: Relative equity for the coverage of RH and MH services has continually increased across all countries over the past quarter century; however, inequities in coverage persist, in some countries more than others. Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage. Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity.

Conclusion: Equity in RH and MH service coverage has improved but varies considerably across countries and over time. Even among the subset of countries that are close to achieving the MDGs, progress made on equity varies considerably across countries. Enduring disparities in access and outcomes underpin mounting support for targeted reforms within the broader context of universal health coverage (UHC).

No MeSH data available.