Co-coverage of reproductive, maternal, newborn and child health interventions shows wide inequalities and is associated with child nutritional outcomes in Ethiopia (2005–2019)
- For policymakers
- Summary created: 2024
Analyzes trends and socioeconomic inequalities in the co-coverage of reproductive, maternal, newborn, and child health (RMNCH) interventions and examines associations with stunting, wasting, and minimum dietary diversity (MDD) among children in Ethiopia.
This summary, including its recommendations and ideas, was created by Kaleab Baye and is based on original research. The original research itself was conducted in collaboration with the following researchers.
Ethiopia’s recent improvements in healthcare and economic conditions have increased access to maternal and child health services, but malnutrition remains prevalent, particularly among low-income, rural populations. Nutrition-specific interventions have been integrated into Ethiopia’s health system to address these issues, yet significant socioeconomic disparities persist, impacting maternal and child nutrition outcomes. The Health Extension Program, a key government initiative, has expanded rural access to health services, but recent studies indicate that healthcare gains have largely favored wealthier and urban populations. Thus, this study aims to assess how inequities in access to RMNCH services-specifically between rural and urban and socioeconomic groups-relate to child nutrition outcomes, such as stunting, wasting, and dietary diversity.
Insights
National co-coverage of RMNCH interventions increased significantly from 2.6/8 in 2005 to 4.1/7 in 2019, yet all interventions displayed a significant pro-rich, pro-urban bias.
Evidence
Co-coverage disparities were most pronounced in skilled delivery assistance (SII: 80.4%), improved water access (SII: 62.6%), and antenatal care (SII: 55.5%), with Vitamin A supplementation showing the lowest inequality (p < 0.05). The mean number of accessed interventions was consistently lower for rural and low-income families.
What it means
Despite overall improvements, the pronounced inequality suggests that urban and wealthier populations benefit disproportionately, potentially leaving rural and poorer families without critical maternal and child health services that can improve nutrition and health outcomes.
Higher RMNCH co-coverage correlates with better nutritional outcomes, such as reduced stunting and wasting and higher MDD among children aged 6–23 months.
Evidence
Each additional intervention accessed (1-unit increase in co-coverage) corresponded to a statistically significant reduction in odds of stunting (adjusted b=-0.008, p=0.008), wasting, and increase in MDD (b=0.017, p<0.01). For households accessing six or more interventions, odds of wasting dropped by 0.049 (CI -0.071, -0.027), and MDD likelihood rose by 0.08 (CI 0.064, 0.096).
What it means
Increasing access to a broader set of RMNCH interventions has a measurable impact on child nutritional outcomes, underscoring the importance of closing gaps in health service access to improve child health and development.
Wealth and urban residence significantly moderated the benefits of RMNCH co-coverage on child nutrition, especially dietary diversity.
Evidence
Stratified analyses revealed that higher co-coverage more strongly benefited urban and wealthier households regarding MDD. For example, accessing six or more interventions correlated with greater MDD for urban (b=0.130, CI 0.090, 0.170) than rural households (b=0.051, CI 0.028, 0.073) and showed stronger effects among the wealthiest quintile (b=0.122, CI 0.083, 0.161).
What it means
These findings suggest that while increasing RMNCH co-coverage can improve child nutrition, structural and socioeconomic factors limit the benefits for poorer, rural households, pointing to the need for targeted policies to address these barriers.
Maternal health interventions provided in health facilities, such as antenatal care and skilled birth attendance, exhibit the greatest inequality and contribute to disparities in early child nutritional outcomes.
Evidence
These interventions were disproportionately accessed by wealthier groups, contributing to poorer early nutrition counseling and breastfeeding guidance for low-income mothers, leading to differences in child stunting and dietary diversity.
What it means
By addressing inequities in facility-based maternal health interventions, policy measures can improve early-life nutrition, particularly for children in low-income and rural families, potentially reducing malnutrition-related disparities.
Suggested next steps
Beyond measuring gains in coverage, it is critical to embed an equity lens to the delivery of proven interventions and make deliberate effort to reach the most remote and deprived, which are those who need the interventions the most.
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