Wealth-based inequalities in the coverage of reproductive, maternal, newborn and child health interventions in 19 countries of the Asia-Pacific region, 1994–2022

Abstract

Objectives

Low- and middle-income countries in the Asia-Pacific region have experienced major health gains in reproductive, maternal, newborn, and child health (RMNCH) since the turn of the millennium. However, some countries and populations remain behind, facing high mortality rates and inadequate access to essential health services. These gaps highlight the urgent need to strengthen service coverage, particularly for unreached and disadvantaged populations. We analyse wealth-based inequalities in RMNCH interventions in this region's low- and middle-income countries and assess coverage gains if such inequalities were eliminated.

Study design

Repeated cross-sectional study.

Methods

Using data from the WHO Health Inequalities Data Repository derived from Demographic and Health Surveys and Multiple Indicator Cluster Surveys we analysed a composite coverage index (CCI) on eight essential RMNCH interventions, disaggregated data were used to assess the latest situation and time trends of national and wealth quintile-specific coverage rates and inequalities using absolute and relative inequality measures (difference, ratio, and slope and relative index of inequality). We further examined countries’ levels and trends in inequalities against their national RMNCH coverage levels. Finally, we calculated impact measures, including the population attributable risk and fraction, to investigate the potential impact on national coverage levels if wealth-based inequalities were eliminated.

Results

Wealth-based inequalities in the RMNCH CCI are prevalent, with the richest quintiles generally having much higher coverage than the poorest. However, countries presented a mixed picture regarding the levels and patterns of wealth-based inequalities. Distinct patterns were observed, including top and bottom inequality distributions and varying trajectories over time, highlighting important country-specific contexts. While countries have seen declines in inequalities over time, in a few countries, gaps in coverage widened. Gains in equality mostly occurred along increased levels of national average coverage. Significant gains in national average CCI could be made by eliminating differences between the coverage in the richest quintile and the rest.

Conclusions

Eliminating inequalities could drive substantial gains in coverage of RMNCH services across the Asia-Pacific region. Countries’ wealth-based inequality patterns can guide policy interventions targeted at unreached and disadvantaged populations.