PT  - JOURNAL ARTICLE
AU  - Marchant, Tanya
AU  - Beaumont, Emma
AU  - Makowiecka, Krystyna
AU  - Berhanu, Della
AU  - Tessema, Tsegahun
AU  - Gautham, Meenakshi
AU  - Singh, Kultar
AU  - Umar, Nasir
AU  - Usman, Adamu Umar
AU  - Tomlin, Keith
AU  - Cousens, Simon
AU  - Allen, Elizabeth
AU  - Schellenberg, Joanna Armstrong
TI  - Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India
AID  - 10.1503/cmaj.190219
DP  - 2019 Oct 28
TA  - Canadian Medical Association Journal
PG  - E1179--E1188
VI  - 191
IP  - 43
4099  - http://www.cmaj.ca/content/191/43/E1179.short
4100  - http://www.cmaj.ca/content/191/43/E1179.full
SO  - CMAJ2019 Oct 28; 191
AB  - BACKGROUND: Despite progress toward meeting the Sustainable Development Goals, a large burden of maternal and neonatal mortality persists for the most vulnerable people in rural areas. We assessed coverage, coverage change and inequity for 8 maternal and newborn health care indicators in parts of rural Nigeria, Ethiopia and India.METHODS: We examined coverage changes and inequity in 2012 and 2015 in 3 high-burden populations where multiple actors were attempting to improve outcomes. We conducted cluster-based household surveys using a structured questionnaire to collect 8 priority indicators, disaggregated by relative household socioeconomic status. Where there was evidence of a change in coverage between 2012 and 2015, we used binomial regression models to assess whether the change reduced inequity.RESULTS: In 2015, we interviewed women with a birth in the previous 12 months in Gombe, Nigeria (n = 1100 women), Ethiopia (n = 404) and Uttar Pradesh, India (n = 584). Among the 8 indicators, 2 positive coverage changes were observed in each of Gombe and Uttar Pradesh, and 5 in Ethiopia. Coverage improvements occurred equally for all socioeconomic groups, with little improvement in inequity. For example, in Ethiopia, coverage of facility delivery almost tripled, increasing from 15% (95% confidence interval [CI] 9%–25%) to 43% (95% CI 33%–54%). This change was similar across socioeconomic groups (p = 0.2). By 2015, the poorest women had about the same facility delivery coverage as the least poor women had had in 2012 (32% and 36%, respectively), but coverage for the least poor had increased to 60%.INTERPRETATION: Although coverage increased equitably because of various community-based interventions, underlying inequities persisted. Action is needed to address the needs of the most vulnerable women, particularly those living in the most rural areas.