Roger Thayer Stone Center For Latin American Studies

Tulane University

UNICEF-Tulane Health Equity Report 2016 Released

December 8th, 2016

The Health Equity Report 2016 by UNICEF and Tulane University, being officially released December 9, reveals inequities. Schooling, income and ethnicity are the main social determinants in the health of children, adolescents and mothers.
  • Indigenous and Afro-descendant women and their children have worse health outcomes and use fewer health care resources.
  • To eradicate inequality, affirmative action‘€“policies that promote and guarantee equal conditions, opportunities and treatment for all‘€“is necessary.

PANAMA CITY, Republic of Panama, 9 December 2016 ‘€” Most of the differences in perinatal, neonatal, infant and under-5 mortality in Latin America and the Caribbean (LAC) are related to maternal wealth and education rather than to rural or urban residence. This is according to the Health Equity Report 2016, a statistical analysis of health indicators that goes beyond national averages to examine the social and economic variables that impact the health status of children, adolescents and mothers in LAC.

The infant mortality rate of infants under one year old whose mothers have low schooling compared to those whose mothers have a secondary or higher education is seven times greater in El Salvador, three times greater in Bolivia, Guatemala, Colombia and the Dominican Republic, and twice as great in Peru. Key socioeconomic characteristics are associated with differences in the use of health services throughout the continuum of maternal and child care and with poorer nutritional status of children.

“Inequality excludes, humiliates and kills,‘€ says UNICEF Regional Director of for Latin America and the Caribbean, María Cristina Perceval, who stresses that ‘€œinequality in health services is a construct, the result of multiple inequities and deprivations since the early years; in most cases, it lasts not only throughout the life cycle but carries enormous potential to replicate beyond particular individuals for generations and generations.‘€ Perceval goes on to argue that ‘€œin order to eradicate vital inequality, affirmative actions, such as policies that promote and guarantee equal conditions, opportunities and treatment for all, are essential, especially for the most disadvantaged.” The report recommends incorporating an ‘€œinequity perspective‘€ in public health research and statistics to both strengthen and expand data on health equity and to document how structural barriers, both social and economic, lead to these inequalities and also change over time.

Revealing statistics
The revised statistics reveal that in 2015, the risk of dying before 28 days of birth in the poorest countries was 2.5 times higher than in richer countries, while the probability of a child dying before reaching the fifth birthday in the lowest income countries was three times higher than in the highest income countries. Indigenous and afro-descendant women receive fewer recommended prenatal visits, are less likely to undergo all recommended health screens tests, and are more than three times more likely to die in childbirth than women of non-indigenous and non-afro-descendant origin.

For Arachu Castro, Director of the Collaborating Group for Equity in Health in Latin America at Tulane University School of Public Health and Tropical Medicine, pregnancy ‘€œincreases vulnerability to sexual violence, which [in turn] increases the likelihood of chronic stress, miscarriage and other obstetric complications, low birth weight and neonatal mortality”.

“This report,” UNICEF Regional Director María Cristina Perceval asserts, “allows us to understand why it is necessary and urgent to overcome the narrow limits of sectorial approaches, emphasizing the legitimacy and need to work within a framework of theories and practices that take into account and assimilate the knowledge and experience of multiple actors and sectors‘€¦to work contextually, in a participatory manner and between and among various institutions from a human rights and equity and gender perspective approach that takes into account the integrity of the life cycle of specific human beings‘€.

UNICEF and the Tulane University Collaboration Group developed the study presented on Friday for Equity in Health in Latin America and the Caribbean within the framework of A Promise Renewed for the Americas and Caribbean movement. It is based on more than 700 statistical sources, including a review of the results of household surveys (demographic and health, multiple cluster indicators, reproductive health and other national surveys) conducted between 2008 and 2014.

To read the Health Equity Report 2016 summary, see this link
To read the full document of the Health Equity Report 2016, see this link
To read a summary in Spanish, see this link. The full version in Spanish will be available soon.

The report will be officially launched from Panama on Friday, December 9. It will be transmitted live on YouTube but it requires registration:
  • For 10 am EST session in Spanish, register here.
  • For 12 pm EST session in English, register here.

UNICEF promotes the rights and well being of every child in everything we do. Together with our partners, we work in 190 countries and territories to translate that commitment into practical action, focusing special effort on reaching the most vulnerable and excluded children to the benefit of all children everywhere. For more information about UNICEF and its work, visit here

About A Promise Renewed for the Americas and Caribbean (APR-LAC)
A Promise Renewed for the Americas and Caribbean (APR-LAC) movement seeks to reduce the profound inequities in reproductive, neonatal, child, adolescent and maternal health that persist in the LAC region. APR-LAC collaborates with key regional stakeholders, including governments, international development agencies, civil society representatives, academic institutions, the private sector, professional institutions, and non-governmental organizations to catalyze and support country-led efforts to decrease gaps in access to quality health care. As a regional movement, APR-LAC works in coordination with the global A Promise Renewed initiative. IADB, PAHO/WHO, UNICEF, USAID and World Bank convene the movement. For further information, visit here

ETHNICITY AND MATERNAL CHILDHOOD HEALTH Women of indigenous populations frequently experience social and economic exclusion, an unequal situation that produces health inequities at numerous moments throughout their lives, especially during pregnancy and labour.
  • Indigenous women in several LAC countries are less likely to deliver with skilled birth attendants.
  • Indigenous and afro-descendant populations show lower health outcomes and less access to health services during pregnancy and childbirth; in addition to generalized social exclusion, there is a growing association between maltreatment in health facilities and poor health outcomes in the indigenous and afro-descendant population.
  • In 2010, indigenous adolescents from Bolivia, Guatemala, Ecuador and Nicaragua had less access to modern family planning services and contraceptive methods compared to the non-indigenous population.
  • Adolescent pregnancy in indigenous populations has declined over the past decade but is still higher compared to non-indigenous adolescents. The prevalence of teenage pregnancy is five times higher in indigenous teens in Costa Rica (49%) than in non-indigenous teens (10%) and almost double in Panama (17% in indigenous compared to 10% in non-indigenous teens).
  • Not only are adolescent pregnancies associated with an increased risk of perinatal complications, but daughters of adolescent mothers may be more likely to become adolescent mothers themselves, thus creating an intergenerational cycle that prevents them from developing their own human capacities.
  • Indigenous and afro-descendant women are at increased risk of illness and death. Afro-Brazilians in Paraná (Brazil) and indigenous women in Guatemala are three times more likely to die in childbirth than non-indigenous women.
SCHOOLING AND MATERNAL CHILDHOOD HEALTH Mothers with lower levels of schooling and their children have less favourable health outcomes than mothers with higher levels of education.
  • Women with lower levels of education in Costa Rica, El Salvador, Guatemala, Panama, Peru and Suriname have an unmet need for contraception at least twice as high as women with secondary or higher education.
  • In Colombia, Haiti, Nicaragua, Panama and Suriname, the coverage rate for prenatal care (at least four visits) is three times lower among women without schooling than among women with higher education levels.
  • In Guatemala, Panama, Haiti and Honduras, women with higher education have greater access to skilled childbirth care than women without schooling.
  • In all LAC countries, postnatal care is less frequent among mothers without schooling or with fewer years of education.
  • Pneumonia is the leading cause of mortality among children aged 1-59 months in LAC. In addition, children with no schooling proportionately receive less medical attention when symptoms of pneumonia appear compared to children of mothers with secondary or higher education.
  • Pregnancy in adolescents is systematically more frequent among those with lower levels of schooling.
  • Mortality is higher among boys and girls whose mothers have little or no schooling compared to children of mothers with secondary or higher education.
  • Bolivia has the largest gaps within a single country: the Neonatal Mortality Rate (NMR under 28 days of birth) is three times higher among women without schooling than among women with higher education.
  • The Infant Mortality Ratio (IMR) among infants (under one year old) whose mothers do not have schooling is greater than among infants whose mothers have a secondary or higher education: seven times greater in El Salvador, three times greater in Bolivia, Guatemala, Colombia and the Republic Dominican Republic and twice as great in Peru.
  • Children of mothers without schooling are more likely to have growth problems compared to children of mothers with secondary or higher education.
  • In Haiti and Colombia, children of mothers with secondary or higher education have greater access to DPT3 and measles vaccines than children of mothers with little or no schooling.
INCOME AND MATERNAL AND CHILDHOOD HEALTH Helping children survive and thrive involves reducing the economic factors associated with infant and under-five mortality.
  • In LAC, an estimated 196,000 children under the age of five died in 2015 (an under-five mortality rate of 18 deaths per 1,000 live births). Of these, 85 per cent (167,000 children) were less than one year old (an infant mortality rate of 15 deaths per 1,000 live births).
  • The poorest percentile of the LAC population has a higher child mortality burden.
  • In 2015, the risk of dying before 28 days of birth in the poorest countries was 2.5 times higher than that of the richest countries.
  • In the LAC region, during 2015, the risk of a child dying before reaching the fifth birthday in the lowest-income countries was three times higher than in the highest-income group.
  • The largest gaps in DPT3 vaccine coverage (diphtheria, tetanus, and whooping cough) are between the richest and poorest in Surinam, Panama, Haiti, and the Dominican Republic.
  • The largest gaps in measles vaccination coverage are between the poorest and the richest in Guyana, Panama, and Suriname.
  • Poverty and low levels of schooling coincide as factors associated with adolescent pregnancy, which is systematically more frequent among teens from the poorest households in all countries with available data.
  • Cuba, Chile, and Costa Rica are examples of countries where inequality has been successfully reduced by narrowing the gap between richer and poorer population groups, mainly by improving women’s access to education and increased public health coverage.
MATERNAL AND NEONATAL MORTALITY IN COUNTRIES Statistics on maternal and infant mortality vary throughout the countries in the region.
  • While Uruguay has a Maternal Mortality Ratio (MMR) of 15 per 100,000 live births, the figure in Haiti is 359 per 100,000 live births and the country with the highest number of maternal deaths is 20 times greater than the country with the lowest number.
  • In the sub regions, this variance between countries is sustained:
  • In the Caribbean, MMR ranged from 27 maternal deaths per 100,000 live births in Barbados and Granada to 39 in Cuba, 92 in the Dominican Republic and 359 in Haiti.
  • In Central America, MMR ranges from 25 in Costa Rica to 150 in Nicaragua.
  • In South America, Uruguay and Chile have an MMR below 25 per 100,000 births, but in Bolivia, the MMR is 206 and in Guyana, 229.
  • In 2015, the highest Neonatal Mortality Ratio (NMR) was reported in Haiti, with an estimated rate of 25.4 neonatal deaths per 1,000 live births. The regional NMR average is 9.3 per 1,000 live births.
    Adolescence is a period of increasing vulnerability, particularly to malnutrition, substance abuse and sexually transmitted infections such as HIV. Inequalities based on income, education, gender or ethnicity can heighten young people’s vulnerabilities to these conditions and have lifelong consequences for their health and well being.
  • The LAC region has the highest concentration of teenage pregnancies in the world: 26 per cent of the births from 2010 to 2015 occurred among adolescents between 15 and 19 years of age.
  • In LAC, as in the world, young women aged 15-24 are 50 per cent more likely to contract HIV than men of the same age.
  • Evidence suggests that current sexual education programs may not sufficiently reach those adolescents most vulnerable to HIV or other STIs. Knowledge about HIV remains incomplete among adolescent boys and girls in the region.
  • Over the last decade, almost all countries in LAC have expanded access to antiretroviral therapy (ART) for children and adolescents.
  • Condom use remains low among adolescents of both sexes throughout the region. Less than four out of ten teenage girls in Peru, the Dominican Republic, Honduras, and Colombia reported using a condom during the most recent sexual relationship to protect themselves against HIV or other STIs.
  • While male teens are more likely to be sexually active, female teens are less likely to use a condom during sex, a trend observed in Nicaragua, Brazil, Mexico, Colombia and Panama.
  • While increased research has brought to light the problems affecting LGBT youth in the region, discrimination continues to hinder these adolescents from achieving optimal mental, physical and sexual health outcomes.
General Latin America + People
William E. Bertrand
Wisner Professor of Public Health - Global Community Health and Behavioral Sciences