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Mesenburg MA, Restrepo-Mendez MC, Amigo H, Balandrán AD, Barbosa-Verdun MA, Caicedo-Velásquez B, Carvajal-Aguirre L, Coimbra CEA, Ferreira LZ, Flores-Quispe MDP, Flores-Ramírez C, Gatica-Dominguez G, Huicho L, Jinesta-Campos K, Krishnadath ISK, Maia FS, Marquez-Callisaya IA, Martinez MM, Mujica OJ, Pingray V, Retamoso A, Ríos-Quituizaca P, Velásquez-Rivas J, Viáfara-López CA, Walrond S, Wehrmeister FC, Del Popolo F, Barros AJ, Victora CG. Ethnic group inequalities in coverage with reproductive, maternal and child health interventions: cross-sectional analyses of national surveys in 16 Latin American and Caribbean countries. Lancet Glob Health 2018; 6:e902-e913. [PMID: 30012271 PMCID: PMC6057134 DOI: 10.1016/s2214-109x(18)30300-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/12/2018] [Accepted: 06/08/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Latin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions. METHODS We analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15-49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12-23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression. FINDINGS Ethnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0·82, IQR 0·66-0·92), antenatal care (0·86, 0·75-0·94), and skilled birth attendants (0·75, 0·68-0·92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries. INTERPRETATION The lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level-such as vaccines-show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes. FUNDING The Bill & Melinda Gates Foundation (through the Countdown to 2030 initiative) and the Wellcome Trust.
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Affiliation(s)
- Marilia Arndt Mesenburg
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil; Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | | | - Hugo Amigo
- Nutrition Department, Universidad de Chile, Santiago, Chile
| | | | | | | | | | - Carlos E A Coimbra
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Brazil
| | - Leonardo Z Ferreira
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil; Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | | | - Giovanna Gatica-Dominguez
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil; Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Luis Huicho
- Centro de Investigación para el Desarrollo Integral y Sostenible, Centro de Investigación en Salud Materna e Infantil and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Ingrid S K Krishnadath
- Department of Public Health, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Fatima S Maia
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil; Department of Public Health, Faculty of Medical Science, Federal University of Rio Grande, Rio Grande, Brazil
| | | | | | | | - Verónica Pingray
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | | | | | | | | | - Fernando C Wehrmeister
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil; Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Aluisio J Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil; Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil; Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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