SDG3-related inequalities in women’s, children’s and adolescents’ health: an SDG monitoring baseline for Latin America and the Caribbean using national cross-sectional surveys

Abstract

ObjectivesLatin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country health inequalities remain. We present a baseline of health inequalities in the region, against which progress towards the SDGs can be monitored.SettingWe studied 21 countries in LAC using data from Demographic and Health Surveys and Multiple Indicator Cluster Survey carried out from 2011 to 2016ParticipantsThe surveys collect nationally representative data on women and children using multistage sampling. In total, 288 207 women and 195 092 children made part of the surveys in the 21 countries.Outcome measuresFive health intervention indicators were studied, related to reproductive and maternal health, along with adolescent fertility and neonatal and under-five mortality rates. Inequalities in these indicators were assessed through absolute and relative measures.ResultsIn most countries, subnational geographical health gradients were observed for nearly all women, child, and adolescent (WCA) indicators. Coverage of key interventions was higher in urban areas and among the richest, compared with rural areas and poorer quintiles. Analyses by woman’s age showed that coverage was lower in adolescent girls than older women for family planning indicators. Pro-urban and pro-rich inequalities were also seen for mortality in most countries.ConclusionsRegional averages hide important health inequalities between countries, but national estimates hide still greater inequalities between subgroups of women, children and adolescents. To achieve the SDG3 targets and leave no one behind, it is essential to close health inequality gaps within as well as between countries.

The Every Woman Every Child initiative: supporting countries in Latin America and the Caribbean to reduce social inequalities in health

“…Particularly, it is important that relevant stakeholders, such as ministries of health, ministries of finance, national statistical institutes, and public and private academic institutions and research centers, collaborate to strengthen national information systems to ensure the collection and reporting for health indicators for women, children, and adolescents disaggregated by equity stratifiers, with data disaggregated at a minimum by age and other relevant characteristics, such as place of residence (rural or urban), race, ethnicity, occupation, education, or socioeconomic status, as well as subnational geographic regions. This would allow countries to monitor social inequalities in health, and especially the inequalities between subgroups to identify those that are left behind, as in [ 15 ], as well as promote intersectoral collaboration, policy formulation, and investment in public health. It is also essential that countries adopt lessons learned and good practices, such as the strengthening of intersectoral work and action at subnational levels, the potential to merge data from different social sectors using the subnational region as a unique common identifier between databases, the corresponding articulation of more holistic interventions that can improve health, and the establishment of health inequality observatories.…”

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 1. Introduction and project description

“…Among the countries of the Western hemisphere, Guatemala has some of the greatest socioeconomic disparities [12,21], health-related inequalities [14,17,22], and ethnic group inequalities in coverage of reproductive, maternal and child health interventions [17]. Guatemala has the highest wealth-related inequality of under-5 mortality in Latin America [22]. It also has the lowest level of government health spending in Latin America, with only 2% of the gross domestic product allocated to public health [23].…”

La iniciativa Todas las Mujeres Todos los Niños brinda apoyo a los países de América Latina y el Caribe para reducir las desigualdades sociales en la salud

“…En particular, es importante que los interesados pertinentes, como los ministerios de salud y de economía, los institutos nacionales de estadística, las instituciones académicas y los centros de investigación públicos y privados, colaboren para fortalecer los sistemas nacionales de información que aseguren la recopilación y presentación de informes sobre indicadores de salud para las mujeres, niños y adolescentes, desglosados por estratificadores de equidad, con datos desglosados como mínimo por edad y otras características pertinentes, como lugar de residencia (rural o urbano), raza, etnicidad, ocupación, escolaridad o situación socioeconómica, así como por regiones geográficas subnacionales. Esto permitiría a los países monitorear las desigualdades sociales en la salud y, en especial, las desigualdades entre grupos para detectar a los que se quedan atrás, como en [15], además de promover la colaboración intersectorial, la formulación de políticas y la inversión en la salud pública. También es esencial que los países adopten las enseñanzas obtenidas y las buenas prácticas, como el fortalecimiento del trabajo y las actividades intersectoriales a nivel subnacional, el potencial de fusionar datos de diferentes sectores sociales utilizando la región subnacional como un identificador común único entre las bases de datos, la articulación correspondiente de intervenciones más holísticas que puedan mejorar la salud, y el establecimiento de observatorios de las desigualdades en la salud.…”