Peer-reviewed article
Reproductive, maternal, newborn, and child health intervention coverage in 70 low-income and middle-income countries, 2000–30: trends, projections, and inequities
Md Mizanur Rahman, Thomas Rouyard, Sumaiya Tasneem Khan, Ryota Nakamura, Md. Rashedul Islam et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed reproductive, maternal, newborn, and child health intervention coverage across 70 low- and middle-income countries from 2000 to 2030 using a composite coverage index that measures eight key interventions including family planning, antenatal care, immunizations, and childhood illness management. The researchers found that coverage has improved overall but only 18 countries are projected to reach the 80% target by 2030. Significant inequities exist within countries, with urban areas, educated populations, and wealthier households having much higher coverage than rural, less-educated, and poorer populations. Different regions show varying trajectories, with most of Asia and Latin America expected to improve, while sub-Saharan Africa lags behind.
Key points
- Only 18 of 70 low- and middle-income countries are projected to reach 80% composite coverage index by 2030
- Southern Asia projected to increase from 51.8% (2000) to 89.2% (2030); sub-Saharan Africa from 46.3% to 72.2%
- Coverage is consistently higher in urban areas compared to rural areas across all measured countries
- Educational level and wealth quintile are strongly associated with RMNCH coverage, with educated and wealthy populations having significantly higher access
- Southern Europe is the only region projected to experience a decline in composite coverage index
Limitations
This is a secondary data analysis using existing data sources, so it cannot determine causation or assess quality of interventions, only their coverage levels. The projections to 2030 depend on assumptions about future trends and cannot account for unexpected policy changes or crises.
Abstract
BACKGROUND: Monitoring the progress in reproductive, maternal, newborn, and child health (RMNCH) using the composite coverage index (CCI) is crucial to evaluate the advancement of low-income and middle-income countries (LMICs) towards the attainment of Sustainable Development Goal target 3. We present current benchmarking for 70 LMICs, forecasting to 2030, and an analysis of inequities within and across countries. METHODS: In this cross-sectional secondary data analysis, we extracted 291 data points from the WHO Equity Monitor, and Demographic and Health Survey Statcompiler for 70 LMICs. We selected countries on the basis of whether they belonged to LMICs, had complete information about the predictors between 2000 and 2030, and had at least one data point related to CCI. CCI was calculated on the basis of eight types of RMNCH interventions in four domains, comprising family planning, antenatal care, immunisations, and management of childhood illnesses. This study examined CCI as the main outcome variable. Bayesian hierarchical models were used to estimate trends and projections of the CCI at regional and national levels, as well as the area of residence, educational level, and wealth quintile. FINDINGS: Despite progress, only 18 countries are projected to reach the 80% CCI target by 2030. Regionally, CCI is projected to increase in all regions of Asia (in southern Asia from 51·8% in 2000 to 89·2% in 2030; in southeastern Asia from 58·8% to 84·4%; in central Asia from 70·3% to 87·0%; in eastern Asia from 76·8% to 82·1%; and in western Asia from 56·5% to 72·1%), Africa (in sub-Saharan Africa from 46·3% in 2000 to 72·2% in 2030 and in northern Africa from 55·0% to 81·7%), and Latin America and the Caribbean (from 67·0% in 2000 to 83·4% in 2030). By contrast, southern Europe is predicted to experience a decline in CCI over the same period (70·1% in 2000 to 55·2% in 2030). Across LMICs, CCIs are higher in urban areas, in populations in which women have higher education levels, and in populations with a high income. INTERPRETATION: Governments of countries where the universal target of 80% CCI has not yet been reached must develop evidence-based policies aimed at enhancing RMNCH coverage. Additionally, they should focus on reducing the extent of existing inequalities within their populations to drive progress in RMNCH. FUNDING: Hitotsubashi University and Japan Society for the Promotion of Science.