The Inverse Equity Hypothesis: Analyses of Institutional Deliveries in 286 National Surveys

Victora, Cesar G; Joseph, Gary; Silva, Inacio C. M.; Maia, Maria de Fátima Santos; Vaughan, J. G.; Barros, Fernando C.; Barros, Aluísio J. D.

doi:10.2105/ajph.2017.304277

Cited by 104 publications

(121 citation statements)

References 40 publications

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“…It proposes that it is the wealthier segments of a population who would initially adopt newly introduced health interventions, increasing absolute inequalities in health, leaving those with a higher vulnerability lagging. Recent research has shown this hypothesis to be true for inequalities in population coverage for institutional deliveries (Victora et al 2018), and this might also be the case for smoking policies.…”

Section: Discussionmentioning

confidence: 92%

Maternal pregnancy smoking in three Brazilian cities: trends and differences according to education, income, and age

Mola

Cardoso

Batista

et al. 2020

Int J Public Health

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Objectives To estimate and assess pregnancy smoking trends since 1978, according to sociodemographic characteristics, in three Brazilian sites. Methods We used cross-sectional data from the perinatal studies of nine birth cohorts, located in the southeast (Ribeirão and 2010) regions of Brazil. We estimated the prevalence of pregnancy smoking at each time point according to age, education, and family income, in each cohort, and evaluated smoking trends. Results We analyzed data of 17,275 women in Ribeirão Preto, 19,819 in Pelotas, and 7753 in São Luís. Smoking decreased by 59% in Ribeirão Preto (p \ 0.001), 54% in Pelotas (p \ 0.001), and 32% in São Luís (p \ 0.001). However, among those with 0-4 years of education, smoking did not change in Ribeirão Preto (p-trend = 0.501) nor São Luís (p = 0.556) and increased in Pelotas (p-trend = 0.003).Conclusions Pregnancy smoking has been declining during the last decades. However, among less-educated women, pregnancy smoking did not change in two sites and increased in one of them.

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Section: Discussionmentioning

confidence: 92%

Maternal pregnancy smoking in three Brazilian cities: trends and differences according to education, income, and age

Mola

Cardoso

Batista

et al. 2020

Int J Public Health

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“…As currently proposed, the index relies on prevalence by wealth quintiles (rather than deciles). It is expressed in percent points, and calculated according to the formula below, where PQ1 stands for prevalence in the poorest quintile, PQ5 prevalence in the richest quintile, and PN the national prevalence [17].…”

Section: Methodsmentioning

confidence: 99%

“…Our present analyses cover both ends of the malnutrition spectrum in women-underweight and overweight or obesity-in a larger number of LMICs than available in earlier studies. In addition to describing the magnitude of socioeconomic inequalities using summary indices, we report on the inequality pattern index, that is, on whether such inequalities are being primarily driven by the poorest or richest groups of women [17].…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic inequalities in the prevalence of underweight, overweight, and obesity among women aged 20–49 in low- and middle-income countries

2019

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Objective To analyze socioeconomic inequalities in the prevalence of underweight and overweight or obesity in women from low and middle-income countries (LMICs). Methods Using the last available Demographic Health Survey between 2010 and 2016 from 49 LMICs, we estimated the prevalence of underweight (BMI < 18.5 kg/m 2) and overweight or obesity combined (BMI ≥ 25 kg/m 2) for women aged 20-49 years. We used linear regression to explore the associations between the two outcomes and gross national income (GNI). We assess within-country socioeconomic inequalities using wealth deciles. The slope index of inequality (SII) and the inequality pattern index (IPI) were calculated for each outcome. Negative values of the latter express bottom inequality (when inequality is driven by the poorest deciles) while positive values express top inequality (driven by the richest deciles). Results In total, 931,145 women were studied. The median prevalence of underweight, overweight or obesity combined, and obesity were 7.3% (range 0.2-20.5%), 31.5% (8.8-85.3%), and 10.2% (1.9-48.8%), respectively. Pearson correlation coefficients with log GNI were −0.33 (p = 0.006) for underweight, 0.72 (p < 0.001) for overweight or obesity, and 0.66 (p < 0.001) for obesity. For underweight, the SII was significantly negative in 38 of the 49 countries indicating a higher burden among poor women. There was no evidence of top or bottom inequality. Overweight or obesity increased significantly with wealth in 44 of the 49 countries. Top inequality was observed in low-prevalence countries, and bottom inequality in high-prevalence countries. Conclusion Underweight remains a problem among the poorest women in poor countries, but overweight and obesity are the prevailing problem as national income increases. In low-prevalence countries, overweight or obesity levels are driven by the higher prevalence among the richest women; as national prevalence increases, only the poorest women are relatively preserved from the epidemic.

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“…Despite strong technical guidance and recommendations for age‐appropriate IYCF practices for children below 2 years (Pan American Health Organization, ; World Health Organization [WHO], ), global progress on these practices has been slow. Socio‐economic inequalities in malnutrition and access to effective nutrition and health services continue to exist throughout the world (Black et al, ; Victora et al, ; Victora & Somers, ). Children living in resource‐poor settings are generally at a greater disadvantage than their wealthier counterparts with respect to living conditions, access to preventive care and complementary feeding practices (Barros, Victora, Scherpbier, & Gwatkin, ), although poorer households are often more likely to breastfeed and to do so for longer periods of time.…”

Section: Introductionmentioning

confidence: 99%

Progress and inequalities in infant and young child feeding practices in India between 2006 and 2016

Nguyen

Avula

Headey

et al. 2018

Maternal & Child Nutrition

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Limited evidence exists on socio‐economic status (SES) inequalities in infant and young child feeding (IYCF) in India. We examine trends and changes in inequalities for IYCF practices over 2006–2016 and identify factors that may explain differences in IYCF across SES groups. We use data from the 2015–2016 and 2005–2006 National Family Health Surveys ( n = 112,133 children < 24 months). We constructed SES quintiles (Q) and assessed inequalities using concentration and slope indices. We applied path analyses to examine the relationship between SES inequalities, intermediate determinants, and IYCF. Breastfeeding improved significantly over 2006–2016: from 23% to 42% for early initiation of breastfeeding (EIBF) and 46% to 55% for exclusive breastfeeding (EBF). Minimum dietary diversity (MDD) improved modestly (15% to 21%), but adequate diet did not change (~9%). Large SES gaps (Q5–Q1) were found for EIBF (8–17%) and EBF (−15% to −10%) in 2006; these gaps closed in 2016. The most inequitable practices in 2006 were MDD and iron‐rich foods (Q5 ~ 2–4 times higher than Q1); these gaps narrowed in 2016, but levels are low across SES groups. Factors along the path from SES inequalities to IYCF practices included health and nutrition services, information access, maternal education, number of children < 5 years, and urban/rural residence. The improvements in breastfeeding and narrowing of equity gaps in IYCF practices in India are significant achievements. However, ensuring the health and well‐being of India's large birth cohort will require more efforts to further improve breastfeeding, and concerted actions to address all aspects of complementary feeding across SES quintiles.

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The Inverse Equity Hypothesis: Analyses of Institutional Deliveries in 286 National Surveys

Cited by 104 publications

References 40 publications

Maternal pregnancy smoking in three Brazilian cities: trends and differences according to education, income, and age

Maternal pregnancy smoking in three Brazilian cities: trends and differences according to education, income, and age

Socioeconomic inequalities in the prevalence of underweight, overweight, and obesity among women aged 20–49 in low- and middle-income countries

Progress and inequalities in infant and young child feeding practices in India between 2006 and 2016

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