Analyses of inequalities in RMNCH: rising to the challenge of the SDGs

Abstract

The Sustainable Development Goal (SDG) 17.18 recommends efforts to increase the availability of data disaggregated by income, gender, age, race, ethnicity, migratory status, disability and geographic location in developing countries. Surveys will continue to be the leading data source for disaggregated data for most dimensions of inequality. We discuss potential advances in the disaggregation of data from national surveys, with a focus on the coverage of reproductive, maternal, newborn and child health indicators (RMNCH). Even though the Millennium Development Goals were focused on national-level progress, monitoring initiatives such as Countdown to 2015 reported on progress in RMNCH coverage according to wealth quintiles, sex of the child, women’s education and age, urban/rural residence and subnational geographic regions. We describe how the granularity of equity analyses may be increased by including additional stratification variables such as wealth deciles, estimated absolute income, ethnicity, migratory status and disability. We also provide examples of analyses of intersectionality between wealth and urban/rural residence (also known as double stratification), sex of the child and age of the woman. Based on these examples, we describe the advantages and limitations of stratified analyses of survey data, including sample size issues and lack of information on the necessary variables in some surveys. We conclude by recommending that, whenever possible, stratified analyses should go beyond the traditional breakdowns by wealth quintiles, sex and residence, to also incorporate the wider dimensions of inequality. Greater granularity of equity analyses will contribute to identify subgroups of women and children who are being left behind and monitor the impact of efforts to reduce inequalities in order to achieve the health SDGs.

National and subnational coverage and inequalities in reproductive, maternal, newborn, child, and sanitary health interventions in Ecuador: a comparative study between 1994 and 2012

“…Socioeconomic status was assessed in this study using an asset index, following the convention used in various Low and Middle-Income Countries (LMICs) [ 7 , 35 – 37 ]. Indicators on active assets of the selected households, materials used for housing construction and types of water and sanitation access facilities were analyzed using Principal Component Analysis (PCA) to generate the wealth score for each household.…”

Measurement and accountability for maternal, newborn and child health: fit for 2030?

“…On the whole, the coverage of healthcare for women and children is increasing and disparities are narrowing in many settings. 7 But despite wide-spread description, the same types of inequalities often persist. Why might this be?…”

Maternal and child health inequalities among migrants: the case of Haiti and the Dominican Republic

“…This study also has strengths. There are few studies of the health effects of migration in low and middle-income countries, as few surveys collect such information (34). The two comparable surveys over a two-year period allowed a comparison of women and children in their countries of origin and of destination.…”