Mendez-Lopez Ana, Mak Rebecca
Department of Preventive Medicine, Public Health and Microbiology, Autonomous University of Madrid, Madrid, Spain.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Public Health. 2025 Nov;248:105941. doi: 10.1016/j.puhe.2025.105941. Epub 2025 Sep 11.
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.
Repeated cross-sectional study.
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.
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.
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.
自世纪之交以来，亚太地区的低收入和中等收入国家在生殖、孕产妇、新生儿和儿童健康（RMNCH）方面取得了重大进展。然而，一些国家和人群仍然落后，面临着高死亡率以及基本卫生服务获取不足的问题。这些差距凸显了加强服务覆盖的迫切需求，特别是针对未被覆盖和处境不利的人群。我们分析了该地区低收入和中等收入国家在RMNCH干预措施方面基于财富的不平等情况，并评估了消除此类不平等后覆盖范围的提升情况。
重复横断面研究。
利用世界卫生组织健康不平等数据存储库中来自人口与健康调查和多指标类集调查的数据，我们分析了八项基本RMNCH干预措施的综合覆盖指数（CCI），使用分类数据，通过绝对和相对不平等衡量指标（差异、比率、斜率和不平等相对指数）来评估国家和财富五分位数特定覆盖率及不平等的最新情况和时间趋势。我们进一步考察了各国不平等水平及其相对于国家RMNCH覆盖水平的趋势。最后，我们计算了影响指标，包括人群归因风险和分数，以研究消除基于财富的不平等对国家覆盖水平的潜在影响。
RMNCH CCI中基于财富的不平等普遍存在，最富有的五分位数人群的覆盖率通常远高于最贫穷的人群。然而，各国在基于财富的不平等水平和模式方面呈现出复杂的情况。观察到了不同的模式，包括顶部和底部不平等分布以及随时间变化的不同轨迹，突出了重要的国家特定背景。虽然随着时间推移各国的不平等有所下降，但在一些国家，覆盖差距却扩大了。平等方面的改善大多伴随着国家平均覆盖率的提高。通过消除最富有五分位数人群与其他人群之间的覆盖率差异，国家平均CCI可取得显著提升。
消除不平等可推动亚太地区RMNCH服务覆盖范围的大幅提升。各国基于财富的不平等模式可为针对未被覆盖和处境不利人群的政策干预提供指导。
