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International Reproductive Health Surveys and Comparative Reports:
Central America Health Equity
Trends |
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Back to Surveys and Comparative
Reports
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—
![Click on Graph 1 for graph details](CA-AMEquityTrends/Graph1sm.jpg) |
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).
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![Click on Graph 2 for graph details](CA-AMEquityTrends/Graph2sm.jpg) |
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%).
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![Click on Graph 3 for graph details](CA-AMEquityTrends/Graph3sm.jpg) |
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%).
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![Click on Graph 4 for graph details](CA-AMEquityTrends/Graph4sm.jpg) |
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%).
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![Click on Graph 5 for graph details](CA-AMEquityTrends/Graph5sm.jpg) |
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.
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![Click on Graph 6 for graph details](CA-AMEquityTrends/Graph6sm.jpg) |
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.
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![Click on Graph 7 for graph details](CA-AMEquityTrends/Graph7sm.jpg) |
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.
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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
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