Equity in newborn care, evidence from national surveys in low- and middle-income countries

Abstract

Background High coverage of care is essential to improving newborn survival; however, gaps exist in access to timely and appropriate newborn care between and within countries. In high mortality burden settings, health inequities due to social and economic factors may also impact on newborn outcomes. This study aimed to examine equity in co-coverage of newborn care interventions in low- and low middle-income countries in sub-Saharan Africa and South Asia. Methods We analysed secondary data from recent Demographic and Health Surveys in 16 countries. We created a co-coverage index of five newborn care interventions. We examined differences in coverage and co-coverage of newborn care interventions by country, place of birth, and wealth quintile. Using multilevel logistic regression, we examined the association between high co-coverage of newborn care (4 or 5 interventions) and social determinants of health. Results Coverage and co-coverage of newborn care showed large between- and within-country gaps for home and facility births, with important inequities based on individual, family, contextual, and structural factors. Wealth-based inequities were smaller amongst facility births compared to non-facility births. Conclusion This analysis underlines the importance of facility birth for improved and more equitable newborn care. Shifting births to facilities, improving facility-based care, and community-based or pro-poor interventions are important to mitigate wealth-based inequities in newborn care, particularly in countries with large differences between the poorest and richest families and in countries with very low coverage of care.

Sources for and quality of neonatal care in 45 low- and middle-income countries

“…Conversely, there were far fewer inequities by maternal age, largely indicating that adolescent and other young mothers do not receive less or poorer-quality care for their newborns as compared to older mothers. This aligns with the findings from a study of 16 low- and middle-income countries found that maternal age was a significant predictor of newborn care only in Senegal and was non-significant in all other countries [ 24 ]. However, we found several disparities between the youngest and oldest maternal age groups in the private for-profit sector.…”

“…Neonates from the poorest households were less likely to be born in a facility and were far less likely to receive care outside the home if they experienced fever. Among neonates born at home with a skilled attendant, those from the poorest households were less likely than those from the wealthiest to receive essential newborn and postnatal care, which aligns with findings from a 2021 study on co-coverage and equity of newborn care [ 24 ]. Socioeconomic disparities were largest among neonates born at home with a SBA and smallest among neonates born in the public sector.…”

Clusters of preterm live births and respiratory distress syndrome-associated neonatal deaths: spatial distribution and cooccurrence patterns

“…Areas with high RDS-associated neonatal mortality are also concentrated in regions characterized by the highest rates of social vulnerability and lower socioeconomic status, with younger mothers, lower maternal schooling, and lower prenatal care visits [ 17 , 45 ]. All these factors are probably associated with higher neonatal mortality rates due to factors that include a poorer access to appropriate newborn care interventions [ 46 ] and to RDS good practices management strategies, contributing to RDS-associated neonatal deaths [ 6 ].…”

Household Survey Measurement of Newborn Postnatal Care: Coverage, Quality Gaps, and Internal Inconsistencies in Responses

“… 11 Co-coverage can more specifically show the proportion of the population receiving most or all of the recommended postnatal care interventions, providing a more granular understanding of gaps in care provision to better inform service development needs. 51 Furthermore, co-coverage can be useful for equity analyses to identify high-risk groups lagging behind 25 , 51 – 54 and may be particularly advantageous when used to replace multiple coverage estimates in multicountry or time trend analyses. 16 , 51 , 55 However, country-specific questionnaire adaptations or differences may inhibit cross-country comparison.…”