Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages

Abstract

BackgroundInequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania.MethodsWe used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up.ResultsIn the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of −0.11 (maternal) and −0.12 (children) to a more equitable concentration index of −0,03 and −0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas.ConclusionsScaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs.

Forward, Together: A Collaborative Path to Comprehensive Adolescent Sexual and Reproductive Health and Rights in Our Time

“…In collaboration with health system strengthening initiatives, we must then ensure that decisionmakers have the adaptive management capacity to use such data to shape (and reshape) their programs. This is especially true at the subnational level, given that there is growing diversity within countries, and that responsibilities for developing work plans and budgets (including in the context of UHC reforms) are increasingly being decentralized [113,114].…”

Millennium Development Goals 4 and 5: Progress in the Least Developed Countries of Asia

“…This paper has given an account of maternal and child health MDGs of LDCs of Asia, granting priority to tackling needs for health care and antenatal and maternal attention to the most disadvantaged segments of the population in making progress towards these Goals. Those most in need are young mothers in the poorest communities of the countries, especially in the neonatal period, along the lines of the results of studies of similar topics, such as Lozano et al (2011);Ruhago et al (2012); Bendavid (2014); and Rodríguez et al (2015).…”

“…Some developing countries still lag behind (Ruhago et al 2012). Moreover, women and children are more vulnerable when it comes to economic inequalities in health and are the first to be affected by economic inequalities.…”

The effects of MCH insurance cards on improving equity in access and use of maternal and child health care services in Tanzania: a mixed methods analysis

“…Inequity in access to and use of child and maternal health services is impeding progress towards the maternal and child health Millennium Development Goals [2, 10]. Statistics from the 2010 Tanzania Demographic and Household Survey (TDHS) show that women in the highest wealth quintile were far more likely to deliver in a facility (90%) than women in the lowest quintile (33%), who were also less likely to have received four or more antenatal care visits and to receive timely postnatal care [11].…”