The World Health Organization (WHO) recently released the State of Inequality Report.

The present report focuses on inequalities pertaining to Reproductive, Maternal and Child Health (RMNCH). It provides details of inequalities with respect to RMNCH indicators between and within countries, country income group, and geographical region.

Key Messages

The report has been compiled by using comparable and public data from 86 low and middle-income countries.

Health inequality:  Observable differences in health between subgroups of a population.

Health inequity: The avoidable and/or unjust differences in health between population subgroups.

Absolute measures of inequality,such as difference, reflect the magnitude of the difference in health status between two subgroups.

Relative measures of inequality, such as ratio, are calculated as the quotient between two subgroups

The use of modern methods of contraception tended to be lowest in women with no education, and generally increased across education levels.

Almost half of low- and middle-income study countries reported that at least 80% of live births were attended by skilled health personnel; however, there was wide variation in the proportion of attended births across countries.

Generally, the proportion of births attended by skilled health personnel was much lower across low-income countries than in middle-income countries.

Overall, the proportion of births attended by skilled health personnel increased with rising economic status: poorer subgroups typically experienced lower levels of skilled birth attendance than richer subgroups.

Half of study countries reported the prevalence of births attended by skilled health personnel to be at least 20 percentage points higher in urban than in rural areas.

One quarter (25%) of study countries reported that antenatal care coverage (at least four visits) was at least twice as high in women with secondary schooling or higher than in women with no education.

Care seeking for children with pneumonia symptoms:

• Three quarters (75%) of low- and middle-income study countries reported a higher level of care-seeking in urban than in rural areas. While 14% of study countries reported the prevalence of care-seeking to be at least 80% in urban areas, only 6% of study countries achieved this level of coverage in rural areas.
• In half (50%) of study countries, there was at least a 20 percentage point gap in care-seeking for children with pneumonia symptoms between the poorest and richest subgroups.

DTP3 Immunization coverage among 1-year olds:

• Overall, DTP3 immunization coverage was lower in children from poorer households.
• Study countries were more likely to report DTP3 immunization coverage of over 80% in richer than in poorer quintiles: 73% of countries achieved this level of coverage among the richest quintile, while only 38% of countries achieved this level of coverage among the poorest quintile.
• In most study countries, there was no – or very little – difference in immunization coverage between boys and girls.

Child Malnutrition:

• In half (50%) of study countries, nearly one in every three children under the age of five years was classified as stunted.
• In most countries, stunting prevalence in children was lower among the subgroup with the highest level of maternal education.
• In most study countries, the prevalence of underweight in children under the age of five years was highest in disadvantaged populations (the poorest, the least educated and those residing in rural areas).
• In over two thirds (75%) of study countries, underweight prevalence in children under five years of age was at least twice as high in the poorest relative to the richest quintiles.

Child Mortality:

• In over half (50%) of low- and middle-income study countries, at least 75 children out of every 1000 live births died before reaching their fifth birthday. The countries reporting the highest under-five mortality rates were in the WHO African Region.
• Whereas half of the middle-income study countries reported child mortality rates in excess of 50 deaths per 1000 live births, half of the low-income study countries had rates of over 100 deaths per 1000 live births.
• The under-five mortality rate was higher in rural areas than in urban areas in most of the low- and middle income study countries.
• In half (50%) of study countries, the infant mortality rate was at least 8 deaths per 1000 live births higher in rural than in urban areas.
• In about one quarter (~25%) of study countries, the gap in neonatal mortality rates between the most- and least-educated subgroups was at least 15 deaths per 1000 live births.

Useful Links:

Link to the press release:

http://who.int/gho/health_equity/report_2015/en/

Link to the Executive Summary of the Report:

http://apps.who.int/iris/bitstream/10665/170970/1/WHO_HIS_HSI_2015.2_eng.pdf?ua=1

Link to the Full report:

http://apps.who.int/iris/bitstream/10665/164590/1/9789241564908_eng.pdf?ua=1&ua=1

Link to Country Profiles (Interactive Graphs) of the Health Equity Monitor:

http://apps.who.int/gho/data/view.wrapper.HE-VIZ11?lang=en&menu=hide

Link to the Information page on the Health Equity Monitor:

http://who.int/gho/health_equity/about/en/