IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0134905.html
   My bibliography  Save this article

Did Equity of Reproductive and Maternal Health Service Coverage Increase during the MDG Era? An Analysis of Trends and Determinants across 74 Low- and Middle-Income Countries

Author

Listed:
  • Sarah Alkenbrack
  • Michael Chaitkin
  • Wu Zeng
  • Taryn Couture
  • Suneeta Sharma

Abstract

Introduction: Despite widespread gains toward the 5th Millennium Development Goal (MDG), pro-rich inequalities in reproductive health (RH) and maternal health (MH) are pervasive throughout the world. As countries enter the post-MDG era and strive toward UHC, it will be important to monitor the extent to which countries are achieving equity of RH and MH service coverage. This study explores how equity of service coverage differs across countries, and explores what policy factors are associated with a country’s progress, or lack thereof, toward more equitable RH and MH service coverage. Methods: We used RH and MH service coverage data from Demographic and Health Surveys (DHS) for 74 countries to examine trends in equity between countries and over time from 1990 to 2014. We examined trends in both relative and absolute equity, and measured relative equity using a concentration index of coverage data grouped by wealth quintile. Through multivariate analysis we examined the relative importance of policy factors, such as political commitment to health, governance, and the level of prepayment, in determining countries’ progress toward greater equity in RH and MH service coverage. Results: Relative equity for the coverage of RH and MH services has continually increased across all countries over the past quarter century; however, inequities in coverage persist, in some countries more than others. Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage. Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity. Conclusion: Equity in RH and MH service coverage has improved but varies considerably across countries and over time. Even among the subset of countries that are close to achieving the MDGs, progress made on equity varies considerably across countries. Enduring disparities in access and outcomes underpin mounting support for targeted reforms within the broader context of universal health coverage (UHC).

Suggested Citation

  • Sarah Alkenbrack & Michael Chaitkin & Wu Zeng & Taryn Couture & Suneeta Sharma, 2015. "Did Equity of Reproductive and Maternal Health Service Coverage Increase during the MDG Era? An Analysis of Trends and Determinants across 74 Low- and Middle-Income Countries," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-22, September.
    • Handle: RePEc:plo:pone00:0134905
    DOI: 10.1371/journal.pone.0134905
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0134905
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0134905&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0134905?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896, December.
    2. Wagstaff, Adam & Bredenkamp, Caryn & Buisman, Leander R., 2014. "Progress toward the health MDGs : are the poor being left behind ?," Policy Research Working Paper Series 6894, The World Bank.
    3. Maureen Lewis, 2006. "Governance and Corruption in Public Health Care Systems," Working Papers 78, Center for Global Development.
    4. Filmer, Deon & Pritchett, Lant, 1999. "The impact of public spending on health: does money matter?," Social Science & Medicine, Elsevier, vol. 49(10), pages 1309-1323, November.
    5. Mats Målqvist & Beibei Yuan & Nadja Trygg & Katarina Selling & Sarah Thomsen, 2013. "Targeted Interventions for Improved Equity in Maternal and Child Health in Low- and Middle-Income Settings: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-10, June.
    6. Deon Filmer & Lant Pritchett, 2001. "Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India," Demography, Springer;Population Association of America (PAA), vol. 38(1), pages 115-132, February.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Mulu Abraha Woldegiorgis & Janet E. Hiller & Wubegzier Mekonnen & Jahar Bhowmik, 2018. "Disparities in maternal health services in sub-Saharan Africa," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 63(4), pages 525-535, May.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Goryakin, Yevgeniy & Suhrcke, Marc & Roberts, Bayard & McKee, Martin, 2015. "Mental health inequalities in 9 former Soviet Union countries: Evidence from the previous decade," Social Science & Medicine, Elsevier, vol. 124(C), pages 142-151.
    2. Christopher H. Herbst & Monique Vledder & Karen Campbell & Mirja Sjöblom & Agnes Soucat, 2011. "The Human Resources for Health Crisis in Zambia : An Outcome of Health Worker Entry, Exit, and Performance within the National Health Labor Market," World Bank Publications - Books, The World Bank Group, number 5938, December.
    3. Philip Stevens, 2010. "Engaging The Private Sector To Improve Health In Africa," Economic Affairs, Wiley Blackwell, vol. 30(3), pages 18-21, October.
    4. Lisa Chauvet & Flore Gubert & Sandrine Mesplé-Somps, 2009. "Are Remittances More Effective Than Aid To Reduce Child Mortality ? An Empirical Assessment using Inter and Intra-Country Data," Working Papers halshs-00966367, HAL.
    5. Ouyang, Yusi & Pinstrup-Andersen, Per, 2012. "Health Inequality between Ethnic Minority and Han Populations in China," World Development, Elsevier, vol. 40(7), pages 1452-1468.
    6. Pulok, Mohammad Habibullah & Sabah, Md Nasim-Us Sabah & Uddin, Jalal & Enemark, Ulrika, 2015. "Progress in utilization of antenatal and delivery care services in Bangladesh: Where does the equity gap lie?," MPRA Paper 63496, University Library of Munich, Germany.
    7. Brown,Caitlin Susan & Kandpal,Eeshani & Lee,Jean Nahrae & Williams,Anaise Marie, 2022. "Unequal Households or Communities ? Decomposing the Inequality in Nutritional Status in South Asia," Policy Research Working Paper Series 10009, The World Bank.
    8. Joseph J. Capuno & Aleli D. Kraft & Stella A. Quimbo & Carlos Antonio, 2013. "Shocks to Philippine Households: incidence, idiosyncrasy, and impact," Philippine Review of Economics, University of the Philippines School of Economics and Philippine Economic Society, vol. 50(2), pages 1-27, December.
    9. Van de Poel, Ellen & Van Doorslaer, Eddy & O’Donnell, Owen, 2012. "Measurement of inequity in health care with heterogeneous response of use to need," Journal of Health Economics, Elsevier, vol. 31(4), pages 676-689.
    10. Olufunke Alaba & Lumbwe Chola, 2014. "Socioeconomic Inequalities in Adult Obesity Prevalence in South Africa: A Decomposition Analysis," IJERPH, MDPI, vol. 11(3), pages 1-20, March.
    11. Jack, William & Lewis, Maureen, 2009. "Health investments and economic growth : macroeconomic evidence and microeconomic foundations," Policy Research Working Paper Series 4877, The World Bank.
    12. Sözmen, Kaan & Ünal, Belgin, 2016. "Explaining inequalities in Health Care Utilization among Turkish adults: Findings from Health Survey 2008," Health Policy, Elsevier, vol. 120(1), pages 100-110.
    13. Asif, Atta Muhammad & Akbar, Muhammad, 2021. "On the decomposition of rank-dependent indicator of socio-economic inequalities in child malnutrition: Some empirical findings," Socio-Economic Planning Sciences, Elsevier, vol. 77(C).
    14. Mansour Farahani & S. V. Subramanian & David Canning, 2010. "Effects of state‐level public spending on health on the mortality probability in India," Health Economics, John Wiley & Sons, Ltd., vol. 19(11), pages 1361-1376, November.
    15. Adam Wagstaff & Daniel Cotlear & Patrick Hoang-Vu Eozenou & Leander R. Buisman, 2016. "Measuring progress towards universal health coverage: with an application to 24 developing countries," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 32(1), pages 147-189.
    16. Aizawa, Toshiaki, 2019. "Ex-ante Inequality of Opportunity in Child Malnutrition: New Evidence from Ten Developing Countries in Asia," Economics & Human Biology, Elsevier, vol. 35(C), pages 144-161.
    17. Boyle, Michael H. & Racine, Yvonne & Georgiades, Katholiki & Snelling, Dana & Hong, Sungjin & Omariba, Walter & Hurley, Patricia & Rao-Melacini, Purnima, 2006. "The influence of economic development level, household wealth and maternal education on child health in the developing world," Social Science & Medicine, Elsevier, vol. 63(8), pages 2242-2254, October.
    18. Wang, Limin, 2003. "Determinants of child mortality in LDCs: Empirical findings from demographic and health surveys," Health Policy, Elsevier, vol. 65(3), pages 277-299, September.
    19. Randive, Bharat & San Sebastian, Miguel & De Costa, Ayesha & Lindholm, Lars, 2014. "Inequalities in institutional delivery uptake and maternal mortality reduction in the context of cash incentive program, Janani Suraksha Yojana: Results from nine states in India," Social Science & Medicine, Elsevier, vol. 123(C), pages 1-6.
    20. Humna Ahsan & Keith Blackburn, 2015. "Human capital and income distribution in a model of corruption," Centre for Growth and Business Cycle Research Discussion Paper Series 208, Economics, The University of Manchester.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0134905. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.