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Highlights from the “Reproductive, Maternal, and Child Health in Central America: Health Equity Trends, 2007”

Using data from Reproductive Health Surveys in four Central American countries, the CDC Division of Reproductive Health has compared health indicators and the use of health care services among the people in the region according to wealth quintiles, which are based on assets in the household at the time of the survey. Issues of equity—whether the poorest segments of a population are receiving and benefiting from basic health care services as much as the wealthier segments—are of great interest to governments and to international donor organizations. A key issue is whether the gains made in national-level indicators are found across all wealth levels, and whether national gains have been achieved by narrowing the gap between the better-off and the less-well-off population segments. Maternal and child health indicators are particularly well suited to this inquiry, as poor health outcomes at young ages may be associated with poor health at older ages.

This report analyzes data from four Central American countries—El Salvador, Guatemala, Honduras, and Nicaragua—that each had a series of three national household surveys conducted between the late 1980s and 2002. The data were analyzed by wealth quintiles—that is, the households were broken down into five equal-sized groups based on assets in the household, with Quintile 1 being the poorest segment and Quintile 5 the wealthiest. Highlights from the report are presented below. You can also order a copy of the report.

Among the highlights of this report are—

	Graph 1: While all four countries have experienced at least some fertility decline, only El Salvador and Nicaragua have seen a narrowing of the fertility gap between the lowest (Q1) and highest (Q5) economic quintiles. In El Salvador, the national total fertility rate (TFR) declined from 3.9 to 3.0 births per woman between 1993 and 2002/2003, while the fertility differential between the lowest and highest quintiles (Q1–Q5) narrowed from 4.2 to 3.4 births per women. Similarly, the national TFR in Nicaragua declined from 4.6 to 3.2, and the differential (Q1–Q5) narrowed from 5.0 to 3.5 births per women between surveys in 1992/1993 and 2001. Guatemala 2002 and Honduras 2001, both with TFRs of 4.4, continue to be among the highest fertility countries in Latin America and to have some of the largest differentials (Q1–Q5) in the region (5.7 births/woman in Guatemala and 4.9 births/woman in Honduras).
	Graph 2: El Salvador, Honduras, and Nicaragua have made progress in reducing the gap between the lowest and highest wealth quintiles in the use of modern contraceptives. Both Guatemala and Honduras continue to have unusually large gaps, of 48.9 and 31.2 percentage points respectively, between Quintiles 1 and 5 in the 2002 survey. (El Salvador and Nicaragua have more modest gaps of 16.3 and 19.0 percentage points respectively.) In El Salvador, Honduras, and Nicaragua, most of the gains in overall contraceptive use have been due to increased use among women in the lower quintiles; there has been little change in the percentage of women in the highest quintile who use a modern contraceptive (range: 61%–72%).
	Graph 3: El Salvador and Nicaragua have made progress toward increasing the use of Antenatal Care (ANC). In El Salvador, use of this service (at least one visit during the pregnancy) increased from 68.7% to 86.0% of live births between 1993 and 2002/2003, and in Nicaragua, use increased from 71.4% to 86.1% between 1992/1993 and 2001. Use of ANC declined slightly in Honduras, from 87.5% to 82.6%, and in Guatemala it increased from 72.7% to 84.3%. Among the four countries, only El Salvador experienced a substantial reduction in the gap between the highest and lowest quintiles (from 34.8 to 19.7 percentage points). However, El Salvador also had the largest Q1–Q5 gap in the earliest survey, and thus had a greater need to reduce it. In Guatemala, the Q1–Q5 gap decreased substantially, from 28.0 to 20.8 percentage points, despite the fact that the overall increase in the percentage of women receiving ANC was modest (from 72.7% to 84.3%).
	Graph 4: This indicator—the percentage of births with delivery by a skilled birth attendant—has the largest discrepancy between the lowest and highest wealth quintiles in the region. The gap between Quintile 5 (wealthiest) and Quintile 1 (poorest) ranges from 52.3 percentage points (El Salvador, 2002/2003) to 82.0 percentage points (Guatemala, 1995). Furthermore, there has been almost no narrowing of the delivery care gap over time in the four countries. The extremely wide gap probably reflects differentials in the availability of skilled birth assistance to the different segments, as well as the inclination to use such services when they are available. Despite the lack of change in this gap between wealth quintiles, the overall national percentage of deliveries by a skilled birth attendant improved for El Salvador (52.4% to 69.7%), Guatemala (29.1% to 41.5%), and Honduras (46.2% to 55.7%).
	Graph 5: This graph presents the percentage of children aged 12–23 months who have had the recommended doses of tuberculosis (BCG), diphtheria, pertussis, and tetanus (DPT), polio, and measles vaccines. The differential between the lowest and highest percentiles for this immunization is comparatively narrow. Only Guatemala in 1987 had a differential of more than 20 percentage points, and in the most recent survey for all four countries, the difference is negligible. This health service is clearly the most equitably distributed of all the services considered in this report. Even when the national vaccination coverage levels are lower than desired, there are no substantial gaps between the least well-off and the most well-off segments of the population.
	Graph 6: This graph presents the percentage of children aged 12–23 months who have had the recommended doses of tuberculosis (BCG), diphtheria, pertussis, and tetanus (DPT), polio, and measles vaccines. The differential between the lowest and highest percentiles for this immunization is comparatively narrow. Only Guatemala in 1987 had a differential of more than 20 percentage points, and in the most recent survey for all four countries, the difference is negligible. This health service is clearly the most equitably distributed of all the services considered in this report. Even when the national vaccination coverage levels are lower than desired, there are no substantial gaps between the least well-off and the most well-off segments of the population.
	Graph 7: This graph presents the percentage of children aged 12–23 months who have had the recommended doses of tuberculosis (BCG), diphtheria, pertussis, and tetanus (DPT), polio, and measles vaccines. The differential between the lowest and highest percentiles for this immunization is comparatively narrow. Only Guatemala in 1987 had a differential of more than 20 percentage points, and in the most recent survey for all four countries, the difference is negligible. This health service is clearly the most equitably distributed of all the services considered in this report. Even when the national vaccination coverage levels are lower than desired, there are no substantial gaps between the least well-off and the most well-off segments of the population.

Page last reviewed: 8/27/08
Page last modified: 8/27/08
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion