Promoting equity to achieve maternal and child health

Thomsen, Sarah; Hoa, Dinh Thi Phuong; Målqvist, Mats; Sanneving, Linda; Saxena, Deepak; Tana, Susilowati; Yuan, Beibei; Byass, Peter

doi:10.1016/s0968-8080(11)38586-2

Cited by 33 publications

(31 citation statements)

References 39 publications

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“…2008-0029 resulting in the Integrated Maternal, Neonatal and Child Health and Nutrition Strategy (MNCHN). Specific reproductive health indicators of MNCHN to be met in 2010 include (1) an increase in modern contraceptive prevalence rate to 60%, (2) an increase in the proportion of pregnant women having at least four ANC visits to 80% and (3) an increase in SBA and facility-based births to 80%.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…1 The slow pace of reduction in maternal death rates despite cost-effective solutions has urged the international community to look beyond accomplishing national targets and to begin addressing wide disparities in women's health. 2 The key to realising equity in maternal health is the achievement of equity in key maternal health coverage, such as antenatal care (ANC) and skilled birth attendance (SBA). A previous study indicated the greatest inequity in SBA coverage followed by ANC of more than four visits.…”

Section: Introductionmentioning

confidence: 99%

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Reduction in inequality in antenatal-care use and persistence of inequality in skilled birth attendance in the Philippines from 1993 to 2008

et al. 2013

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ObjectiveTo assess changes in the inequalities associated with maternal healthcare use according to economic status in the Philippines.DesignAn analysis of four population-based data sets that were conducted between 1993 and 2008.SettingPhilippines.ParticipantsWomen aged 15–49 years who had a live-birth within 1 year in 1993 (n=1707), 1998 (n=1513), 2003 (n=1325) and 2008 (n=1209).OutcomesAt least four visits of antenatal care, skilled birth attendance and delivery in a medical facility.ResultsThe adjusted OR for antenatal-care use when comparing the highest wealth-index quintile with the lowest quintile declined from 1993 to 2008: 3.43 (95% CI 2.22 to 5.28) to 2.87 (95% CI 1.31 to 6.29). On the other hand, the adjusted OR for the other two outcome indicators by the wealth index widened from 1993 to 2008: 9.92 (95% CI 5.98 to 16.43) to 15.53 (95% CI 6.90 to 34.94) for skilled birth attendance and 7.74 (95% CI 4.22 to 14.21) to 16.00 (95% CI 7.99 to 32.02) for delivery in a medical facility. The concentration indices for maternal health utilisation in 1993 and 2008 were 0.19 and 0.09 for antenatal care; 0.26 and 0.24 for skilled birth attendance and 0.41 and 0.35 for delivery in a medical facility.ConclusionsOver a 16-year period, gradients in antenatal-care use decreased and the high level of inequalities in skilled birth attendance and delivery in a medical facility persisted. The results showed a disproportionate use of institutional care at birth among disadvantaged Filipino women.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reduction in inequality in antenatal-care use and persistence of inequality in skilled birth attendance in the Philippines from 1993 to 2008

et al. 2013

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“…As shown in figure 2, there is a direct correlation between GDP and child mortality, and also between a country's level of poverty, as expressed by the poverty gap, and child mortality (figure 2). Thus, promoting equity becomes important for MDG 1 and for the health-related MDGs,19 for example in the small kingdom of Swaziland, where it is estimated 40–60% of the population live below the poverty line, despite the kingdom's GDP placing it among middle-income countries (table 4). As the child mortality rate in Swaziland is actually increasing, mostly due to unsuccessful attempts to prevent mother-to-child transmission of HIV, it is clear that uneven distribution of wealth results in human suffering.…”

Section: Equity Is Keymentioning

confidence: 99%

Abolishing inequity, a necessity for poverty reduction and the realisation of child mortality targets

Målqvist

2015

Arch Dis Child

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The first Millennium Development Goal (MDG 1) due in 2015 concerns poverty reduction. It has been claimed to be fulfilled on a global level, but still more than 1 billion people are living in abject poverty. There is a strong link between the economy and child survival, and only a minority of countries will have reached the MDG target for child mortality reduction by 2015. This paper discusses the relationship between poverty and child survival. It argues that a focus on equity is necessary to further reduce child mortality, through poverty reduction in absolute terms and also through targeting interventions for increased child survival to disadvantaged populations. The political will to actually achieve real change for those in greatest need is crucial but not to be taken for granted, and the distribution rather than the generation of wealth needs to be made a priority in the post-MDG era. INTRODUCTIONThe first Millennium Development Goal (MDG 1) deals with the allocation of resources and halving the rate of extreme poverty and hunger by 2015 compared to the level in 1990.1 It has been claimed that this goal was fulfilled some years ago.1 2 The proportion of extremely poor people living on less than US$1.25 a day has decreased, but the population has grown and today more than 1 billion people still live in abject poverty. 1 2 Furthermore, the global success in reaching the first MDG can to a large extent be attributed to the tremendous economic development in East Asia over the past two decades (tables 1-4).3 China alone has made a major contribution to the achievement of MDG 1. However, not much has happened in Africa. In countries like Kenya, Nigeria and Zambia, the ratio of people living on less than US $1.25 a day has actually increased (table 4).2 3 This raises the question whether achieving MDG 1 was due to the MDG effort or was just the result of inevitable development as the most populous country on Earth reached a developmental tipping point. This suggestion has both positive and negative implications-positive in the sense that once the economy of a developing society reaches a critical mass the rate of poverty will decrease as a result, and negative in the sense that world community efforts may ultimately be irrelevant as macroeconomics have a dynamic of their own. However, people drive development and changes can be made, for example, in child mortality. The so-called 'child survival revolution' from the 1970s to the turn of the millennium, when under-5 mortality fell substantially worldwide, 4 testifies to the possibility of achieving change with determination and effort unrelated to economic development. For example, before it experienced the tremendous economic development of later years, Vietnam managed to reduce child mortality from 55/1000 to 30/1000 live births through community mobilisation and a deliberate effort to improve public health through large-scale programmes for immunisation and health awareness. 5 The effort in the last 10 years to reduce neonatal mortality globally is ano...

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“…The Eight Millennium Development Goals focus on maternal and child mortality because these indicators are signs of health inequity (9). Although primary care systems are highly important in the health sector, hospitals have an important role in health outcomes (10).…”

Section: Introductionmentioning

confidence: 99%