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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

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  • Sarah Alkenbrack
  • Michael Chaitkin
  • Wu Zeng
  • Taryn Couture
  • Suneeta Sharma

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).

Suggested Citation

  • Sarah Alkenbrack & Michael Chaitkin & Wu Zeng & Taryn Couture & Suneeta Sharma, 2015. "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," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-22, September.
    • Handle: RePEc:plo:pone00:0134905
    DOI: 10.1371/journal.pone.0134905
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    References listed on IDEAS

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    1. Mats Målqvist & Beibei Yuan & Nadja Trygg & Katarina Selling & Sarah Thomsen, 2013. "Targeted Interventions for Improved Equity in Maternal and Child Health in Low- and Middle-Income Settings: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-10, June.
    2. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896.
    3. Wagstaff, Adam & Bredenkamp, Caryn & Buisman, Leander R., 2014. "Progress toward the health MDGs : are the poor being left behind ?," Policy Research Working Paper Series 6894, The World Bank.
    4. Deon Filmer & Lant Pritchett, 2001. "Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India," Demography, Springer;Population Association of America (PAA), vol. 38(1), pages 115-132, February.
    5. Maureen Lewis, 2006. "Governance and Corruption in Public Health Care Systems," Working Papers 78, Center for Global Development.
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    1. Mulu Abraha Woldegiorgis & Janet E. Hiller & Wubegzier Mekonnen & Jahar Bhowmik, 2018. "Disparities in maternal health services in sub-Saharan Africa," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 63(4), pages 525-535, May.

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