This blog is part of a series to coincide with A Promise Renewed in the Americas: ”Reducing Inequalities in Reproductive, Maternal and Child Health Summit“ during September 10-12 in Panama.
In the past decade, most economies in Latin America and Caribbean (LAC) have grown at a rapid pace, which has allowed an approximate 70 million people to rise out of poverty and approximately 50 million to join the middle class. Despite the recent global economic slowdown, the World Bank expects the region to see a 3.5 percent average GDP growth rate this year.
Unfortunately, this growth has not benefited everyone in the region. Household living standards and availability of social services, including health and education, are still low for millions of people. This in turn, is reflected in major variations in health indicators, both between and within countries in the region. Among disadvantaged groups, the chance of death or permanent ill-health is much higher than for the middle- and upper-classes. Eliminating preventable maternal, newborn and child deaths globally is an overarching goal of USAID’s work, so we must address the underlying causes.
There has been significant progress in Latin America and the Caribbean in recent decades. Many countries have reached or exceeded their Millennium Development Goal (MDG) 5 levels, reducing maternal deaths by 75 percent between 1990 and 2015. Most LAC countries will meet the MDG 4 goal of reducing under-five deaths by two-thirds over that period.
Moreover, many countries have or will soon achieve the new global goal of ending preventable child deaths (defined as an under-5 mortality rate of 20 deaths per 1,000 live births) by 2035. Currently, ten other countries in the region have under-five mortality rates between 20 and 30. Only Haiti (70), Bolivia (51) and Guyana (36) have an above 30 mortality rate. However, nationally averaged numbers mask health inequalities within many of the region’s countries, so variations among population sub-groups must be taken into account to understand that risk of death is not evenly distributed. In Latin America and the Caribbean, over 180,000 children under 5 years old and nearly 9,000 mothers still die annually — most of them among poor, indigenous, and marginalized groups.
The impact of sub-group disparities on key health indicators, such as under-five mortality is well established – but it is telling to compare LAC with other regions. This indicator is higher in rural than in urban areas across the world, but the largest gap is in Latin America. Overall, in developing countries, under-five mortality is 50 percent higher in rural areas, whereas for Latin America under-five mortality is 70 percent higher in rural areas. Similarly, under-five mortality in LAC is almost three times higher among the poorest quintile than the richest quintile, which is the worst ratio worldwide; the average among developing regions is less than two times higher among the poorest quintile.
Another area where inequities lead to stark differences in health status is in regard to nutrition. According to estimates based on household income, 13 percent of LAC’s population lives in households with incomes insufficient to satisfy their basic nutritional needs. Given that the 2013 Lancet series on nutrition found that “undernutrition is responsible for 45 percent of deaths of children younger than 5 years,” addressing these inequities with regard to basic needs is critical to reducing child mortality in the region. According to the Lancet, “[t]he effect on maternal and child health outcomes and health-care provision is striking, regardless of the indicator used to measure inequity. For example, maternal mortality ratios are 10-44 times higher in the poorest provinces of several countries in Latin America. The poorest quintile of the population showed 3-10 times the prevalence of stunted children than the richest quintile in nine countries.”
Fortunately, LAC has developed a number of tools to address inequities. For example, the region pioneered to use of conditional cash transfers. Starting in the late 1990s, Brazil and Mexico began experimenting with these programs, which aimed to reduce poverty and improve health and other outcomes through provision of incentive payments for certain behaviors. The innovative approach spread throughout the region, so that by 2011 eighteen countries had a CCT program, with a total of 129 million beneficiaries. Rigorous program evaluations have found CCTs to increase demand for health services and reduce poverty, although they should be carefully targeted to the poor to reduce inequities and often require improvements in the quality of care to maximize health impact. Conditional Cash Transfers are a successful example of the benefits that can be gained through consideration of the broader context to health. In addition, the region has pioneered cost-effective approaches to infant and child health, such as integrated management of childhood illness and Kangaroo Mother Care, which can be used to improve health in a variety of settings, particularly resource-constrained ones.
The regional Promise Renewed event taking place in Panama this week aims to build momentum for countries and partners in the region to address inequities that impact health status. It’s too early to declare victory in the area of maternal and child health in the LAC region. We must work together to address remaining pockets of need in order to continue to reduce maternal and child mortality, and we should do so by building upon the region’s experience, expertise, and sense of solidarity.
Please join us via Livestream to learn more about the A Promise Renewed in the Americas: ”Reducing Inequalities in Reproductive, Maternal and Child Health Summit.