According to a study that tracks the progress towards the Millennium Development that promotes maternal and child health (Goals 4 and 5), researchers from the University of Pelotas in Brazil discovered that the most equitable intervention was early initiation of breast feeding, and that the attendance of a skilled person at birth proved to be the least equitable intervention. The study is published in this week’s edition of The Lancet.

Since the Millenium Goal’s inception, the ‘Countdown’ towards 2015 has highlighted the need to tackle maternal and child health inequalities as a key approach for better health and survival. Dr Aluisio J D Barros and his team decided to re-analyze data for 12 maternal, newborn, and child health interventions from national surveys conducted in 54 ‘Countdown’ countries between Jan 1, 2000, and Dec 31, 2008.

The findings revealed that the least equitable intervention was skilled birth attendant coverage followed by four or more antenatal care visits, whilst the most equitable intervention turned out to be early initiation of breastfeeding. The most inequitable countries of the evaluated interventions were Chad, Ethiopia, Laos, Nigeria, Niger and Somalia, followed by India, Madagascar and Pakistan, with the most equitable countries being Kyrgyzstan and Uzbekistan.

The findings furthermore revealed that community-based interventions were more equally distributed in comparison with those delivered in health facilities. The variability of the overall intervention coverage between the different countries was greater amongst the poorest than the richest people.

The researchers remark:

“Inter-country variability in intervention coverage is much greater for the poorest wealth quintile in each country than for the richest, which suggests that even in the poorest countries, wealthier individuals have mechanisms for gaining access to lifesaving interventions.”

They summarize saying that:

“Immediate implications of our results include the need to give special attention, nationally, regionally, and internationally, to the most inequitable interventions. Community-based interventions were generally more equally distributed than were service-based interventions, which indicate that additional efforts are needed to reach the poorest individuals with such interventions. The most inequitable Countdown countries need renewed efforts from the international community.”

An associated comment made by Dr Robert l Goldenberg of the Department of Obstetrics and Gynecology at the Drexel University College of Medicine in Philadelphia, PA, USA, and Dr Elizabeth M McClure, both from the Research Triangle Institute, Research Triangle Park, NC, USA, state:

“The Countdown to 2015 process is an excellent example of use of rigorously collected data to monitor health programs and improve health outcomes. Similar data can be used across and within countries to assess disparities in care provision, which makes this process especially valuable.

Reductions in within-country disparities in coverage are most likely to be achieved within a functioning health system that uses data to establish goals for both outcomes and coverage, nationally, regionally, and locally.”

Written by Petra Rattue