1. International Center for Equity in Health
The role of ethnicity as a determinant of reproductive, maternal, newborn and child health in Latin America and the Caribbean
Marilia Arndt Mesenburg, with collaboration of colleagues from 16 countries
International Center for Equity in Health

2. Background
The Sustainable Development Goals ( ) call for disaggregated statistics according to ethnic group
Ethnicity is difficult to measure in a consistent or standardized way
Three major ethnic groups in LAC region: indigenous, afrodescendants and Europeans
Limited information on relation between ethnicity and coverage with reproductive, maternal, newborn and child health (RMNCH) interventions

3. Research questions
1) Is the coverage with RMNCH interventions different among the three major ethnic groups?
2) To what extent do the differences in terms of wealth, urban-rural residence and formal education explain the ethnic inequalities?

4. Data source
 About 80% of the region´s population
6 Demographic and Health Surveys (DHS)
7 Multiple Indicators Cluster Surveys (MICS)
3 Reproductive Health Surveys (RHS)
 We analyzed standardized national surveys carried out in 16 countries (2004 to 2015)

5. Outcomes: coverage with
Women aged years
Modern contraceptive
Antenatal care – four or more visits
Skilled birth attendant
Children aged months
Diphtheria, tetanus, and pertussis vaccine (DPT)

6. Stratification variable
Ethnicity
Three broad categories
Self reported ethnic affiliation, language or skin color
Indigenous
Afrodescendants
Reference category (European descendants, mixed ancestry, etc.)
Mediating variables
Wealth quintiles
Urban-rural residence
Women´s education (none, primary or secondary+)

7. Analysis Individual level Descriptive analysis
Crude and adjusted coverage ratios
Ethical approval
Obtained by the national agencies responsible for each survey
CR = indigenous coverage
reference coverage
CR = afrodescendants coverage
reference coverage

8. Indigenous people are disadvantaged
In general, indigenous women and children were
poorer
more rural
received less formal education
Median coverage ratio for indigenous
Indicator
Crude
Adjusted
Modern contraceptive
0.82
0.85
Antenatal care
0.86
0.89
Skilled birth attendant
0.75
0.90
DPT vaccine
0.95
0.96

9. Lower coverage among indigenous women in several countries

10. Similar coverage for DPT vaccination in indigenous children

11. Afrodescendants: less marked inequalities
Median coverage ratios for afrodescendants
differences were less marked than for indigenous
Indicator
Crude
Adjusted
Modern contraceptive
0.94
Antenatal care
0.96
0.98
Skilled birth attendant
1.00
0.99
DPT vaccine

12. Limitations
Use of three self-reported variables as proxies of ethnic group affiliation
Language information hides afrodescendants
The reference group varied from country to country and includes many women and children with mixed European, indigenous and African ancestries
Use of a single indigenous category
Analyses restricted to interventions available for many years, that have reached high coverage in most countries

13. Summing up Important gaps in RMNCH coverage according ethnic group
Marked variability among countries precluded meta-analysis
The gaps persist after adjustment for socioeconomic factors
Inequalities for afrodescendants are less marked than for indigenous
Continued monitoring of ethnic inequalities
assessing the impact of inclusive policies
guiding future policy and implementation initiatives

14. Thank you