Ethnic Inequalities in Reproductive, Maternal, Newborn and Child Health Interventions in Ecuador: A Study of the 2004 and 2012 National Surveys

Abstract

Objectives: Analysis of health inequalities by ethnicity is critical to achieving the Sustainable Development Goals. In Ecuador, similar to other Latin-American countries, indigenous and afro-descendant populations have long been subject to racism, discrimination, and inequitable treatment. Although in recent years, Ecuador has made progress in health indicators, particularly those related to the coverage of Reproductive, Maternal, Neonatal and Child health (RMNCH) interventions, little is known if inequalities by ethnicity persist. Design: Analysis was based on two nationally representative health surveys (2004 and 2012). Ethnicity was self-reported and classified into three categories (Indigenous/Afro-Ecuadorian/Mixed ancestry). Six RMNCH health intervention coverages were selected. Coverage for each ethnic group was stratified by level of education, area of residence and wealth quintiles. Absolute inequality measures and multivariate analysis using Poisson regression was undertaken. Results: In 2012, 74.4% of women self-identifying as indigenous did not achieve the secondary level of education and 50.7% were in the poorest quintile (Q1); this profile was relatively unchanged since 2004. From 2004 to 2012 the coverage of RMNCH interventions increased for all ethnic groups, and absolute inequality decreased. However, in 2012, regardless of education level, area of residence and wealth quintiles, ethnic inequalities remained for almost all RMNCH interventions. Indigenous had 24% lower prevalence of modern contraceptive use (Prevalence ratio [PR]=0.76; 95% IC: 0.7-0.8); 28% less prevalence of antenatal care (PR=0.72; 95% IC: 0.6-0.8); and 35% of less prevalence of skilled birth attendance and institutional delivery (PR=0.65; 95% IC: 0.6-0.7 and PR=0.65; 95% IC: 0.6-0.7 respectively), compared with the majority ethnic group in the country. Conclusion: While the gaps have narrowed, indigenous people in Ecuador continue in a situation of structural racism and are left behind in terms of access to RMNCH interventions. Strategies to reduce ethnic inequalities in the coverage services need to be collaboratively redesigned/co-designed. Funding Information: This paper was made possible with funds from the Bill & Melinda Gates Foundation [Grant Number: INV-007594/OPP1148933]. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The institutions that carried out the surveys received the relevant ethical approvals.