Progress in reducing inequalities in reproductive, maternal, newborn,' and child health in Latin America and the Caribbean: an unfinished agenda.
OBJECTIVE
To expand the "Countdown to 2015" analyses of health inequalities beyond the 75 countries being monitored worldwide to include all countries in Latin America and the Caribbean (LAC) that have adequate data available.


METHODS
Demographic and Health Surveys and Multiple Indicator Cluster Surveys were used to monitor progress in health intervention coverage and inequalities in 13 LAC countries, five of which are included in the Countdown (Bolivia, Brazil, Guatemala, Haiti, and Peru) and eight that are not (Belize, Colombia, Costa Rica, Dominican Republic, Guyana, Honduras, Nicaragua, and Suriname). The outcomes included neonatal and under-5 year mortality rates, child stunting prevalence, and the composite coverage index-a weighted average of eight indicators of coverage in reproductive, maternal, newborn, and child health. The slope index of inequality and concentration index were used to assess absolute and relative inequalities.


RESULTS
The composite coverage index showed monotonic patterns over wealth quintiles, with lowest levels in the poorest quintile. Under-5 and neonatal mortality as well as stunting prevalence were highest among the poor. In most countries, intervention coverage increased, while under-5 mortality and stunting prevalence fell most rapidly among the poor, so that inequalities were reduced over time. However, Bolivia, Guatemala, Haiti, Nicaragua, and Peru still show marked inequalities. Brazil has practically eliminated inequalities in stunting.


CONCLUSIONS
LAC countries presented substantial progress in terms of reducing inequalities in reproductive, maternal, newborn, and child health interventions, child mortality, and nutrition. However, the poorest 20% of the population in most countries is still lagging behind, and renewed actions are needed to improve equity.
International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil, mcm.restrepo@gmail.com.
María Clara
MC
Restrepo-Méndez
International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil, mcm.restrepo@gmail.com.
Aluísio J D
AJ
Barros
Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland.
Jennifer
J
Requejo
Centro Latino Americano de Perinatología, Organización Panamericana de la Salud, Montevideo, Uruguay.
Pablo
P
Durán
Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland.
Luis Andrés de Francisco
LA
Serpa
International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil, mcm.restrepo@gmail.com.
Giovanny V A
GV
França
International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil, mcm.restrepo@gmail.com.
Fernando C
FC
Wehrmeister
International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil, mcm.restrepo@gmail.com.
Cesar G
CG
Victora
D017691:Caribbean Region / Q000453:epidemiology; D002648:Child; D000067576:Child Health; D046688:Child Mortality / Q000639:trends; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000517:prevention & control; D000069576:Health Equity; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D000068104:Infant Health; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007843:Latin America / Q000453:epidemiology; D000068097:Maternal Health; D008507:Medically Underserved Area; D009017:Morbidity / Q000639:trends; D011203:Poverty; D015995:Prevalence; D060728:Reproductive Health