Achieving MDG5: Ensuring Equitable Coverage of Maternal Health Interventions

The fifth Millennium Development Goal (MDG) on maternal health is the most conspicuous failure amongst the MDGs. The lack of an equity focus inherent to the goals has been highlighted previously, with previous studies showing that the population average measurement hides large differences in mortality and morbidity between rich and poor. Skilled birth attendance (SBA) is an important indictor used to monitor maternal health and suffers from great inequality. This paper studies inequality in SBA by socioeconomic status and place of residence for 30 countries over time and highlights countries that have managed to increase SBA more equitably than others. A framework is proposed showing that inequality is a universal stage through which systems pass as maternal health care for a population is improved. There is an ‘inequality transition’, with different groups obtaining skilled attendance at different times. Inequity is an undesirable but unavoidable side effect of progress. The paper outlines how this transition can be used for monitoring and researching equitable progress towards MDG5 and indicates policies that can be enacted at each stage of the framework to reduce inequalities.