Mesenburg MA, et al. - Researchers investigated the ethnic inequalities among Latin American and Caribbean populations (including three main ethnic groups: indigenous people, people of African descent, and people of European descent) in population coverage with reproductive, maternal, newborn, and child health interventions. Indigenous women displayed prevalent low coverage levels that cannot be explained merely by differences in wealth, education, or residence. Less inequality was evident for interventions delivered at community level, such as vaccines, than those requiring access to services, such as birth attendance. In order to plan effective multisectoral policies and programs, ethnic inequalities should be regularly monitored so existing initiatives aimed at the inclusion of minorities can be evaluated.

Methods

• Sixteen standardized, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean were analyzed.
• These surveys provided information on ethnicity or a proxy indicator (household language or skin color) and on coverage of reproductive, maternal, newborn, and child health interventions.
• Following 4 outcomes were selected: 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.
• On the basis of their self-reported ethnicity or language, women and children were classified as indigenous, of African descent, or other ancestry (reference group).
• Wealth quintiles (based on household asset indices), woman's education, and urban-rural residence were included as mediating variables.
• Using Poisson regression, crude and adjusted coverage ratios were calculated.

Results

• Countries displayed substantial variation in terms of ethnic gaps in coverage.
• In most countries, indigenous women showed lower 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) than women in the reference group.
• The indigenous and the reference groups displayed significant gaps in DPT3 coverage only in three countries (Nicaragua, Panama, and Paraguay).
• Lessened but persistent differences were noted after adjustment for wealth, education, and residence.
• In most countries, women and children of African descent showed similar coverage to the reference group.