Meeting the Global Target in Reproductive, Maternal, Newborn, and Child Health Care Services in Low- and Middle-Income Countries

Abstract

Introduction: Improving reproductive, maternal, newborn, and child health (RMNCH) care services is imperative for reducing maternal and child mortality. Many low- and middle-income countries (LMICs) are striving to achieve RMNCH-related Sustainable Development Goals (SDGs). We monitored progress, made projections, and calculated the average annual rate of change needed to achieve universal (100%) access of RMNCH service indicators by 2030.

Methods: We extracted Demographic and Health Survey (DHS) data of 75 LMICs to estimate the coverage of RMNCH indicators and composite coverage index (CCI) to measure health system strengths. Bayesian linear regression models were fitted to predict the coverage of indicators and the probability of achieving targets.

Results: The projection analysis included 64 countries with available information for at least 2 DHS rounds. No countries are projected to reach universal CCI by 2030; only Brazil, Cambodia, Colombia, Honduras, Morocco, and Sierra Leone will have more than 90% CCI. None of the LMICs will achieve universal coverage of all RMNCH indicators by 2030, although some may achieve universal coverage for specific services. To meet targets for universal service access by 2030, most LMICs must attain a 2-fold increase in the coverage of indicators from 2019 to 2030. Coverage of RMNCH indicators, the probability of target attainments, and the required rate of increase vary significantly across the spectrum of sociodemographic disadvantages. Most countries with poor historical and current trends for RMNCH coverage are likely to experience a similar scenario in 2030. Countries with lower coverage had higher disparities across the subgroups of wealth, place of residence, and women's/mother's education and age; these disparities are projected to persist in 2030.

Conclusion: None of the LMICs will meet the SDG RMNCH 2030 targets without scaling up essential RMNCH interventions, reducing gaps in coverage, and reaching marginalized and disadvantaged populations.

FIGURE 1.

Progress and Projections of Composite Coverage Index in Low- and Middle-Income Countries Abbreviation: CCI, composite coverage index.

FIGURE 2.

Projected Coverage in Percentages of Composite Coverage Index in 2030 Across Countries^a Abbreviation: CCI, composite coverage index.^a Values in parentheses represent the number of surveys of the respective country that were used in the analysis.

FIGURE 3.

Trends in Predicted Composite Coverage Index Across Countries by Wealth Quintiles

FIGURE 4.

Projected Gaps in Composite Coverage Index Across Countries by Wealth Quintiles, Place of Residence, and Women’s/Mother’s Education and Age in 2030 Abbreviations: NPE, no education and primary-level education; SHE, secondary or higher-level education.

FIGURE 5.

Average Annual Rate of Change^a in Composite Coverage Index in Low- and Middle-Income Countries ^a Annual rate of change is calculated as: ln[(rate in latest year/rate in earliest year)]/(latest year − earliest year), with positive values located on the right side of the diagonal line at 0 (in X-axis) denoting an increasing rate, while negative values located on the left side of the diagonal line at 0 (in X-axis) denoting a decreasing rate.