Title: Socio-economic inequalities and the MDGs: building evidence to support equitable improvement in maternal and newborn health in Asia & Africa
Funder: Economic and Social Research Council

Abstract: Our proposal relates primarily to the 'Inequality and Development' and secondarily to the 'Population and Development' research highlight notice for this call. Progress towards the Millennium Development Goals (MDGs) has been highly uneven. Poor and otherwise disadvantaged groups are lagging behind their more fortunate fellow-citizens for most MDGs and inequalities in human development remain large. In particular, inequalities in maternal and child health are huge. Childhood mortality is, for example, systematically higher among the poor than among the better-off within the same country. The link between socio-economic disadvantage and health disadvantage has enormous consequences: one third of global childhood deaths, for instance, are attributable to socio-economic mortality inequalities within countries. To make things worse, effective interventions are known, but rarely reach those who need them most. These large and persistent inequalities between socio-economic groups in human development and in progress towards the MDGs have been highlighted by donors and international agencies as a critical development problem. Unfortunately, there is a paucity of evidence about inequality in the health outcomes that lag the most: newborn and maternal mortality. And, little is known about how to effectively reach poor and otherwise disadvantaged groups, and how to address socio-economic inequalities in mortality. Our project aims to fill these critical evidence gaps by generating robust evidence on (1) how socio-economic and gender inequalities translate into inequalities in maternal and newborn mortality within countries, (2) how to address the exclusion of poor and otherwise marginalised groups from efforts to achieve the MDGs, and (3) how to reduce socio-economic inequalities in maternal and newborn mortality. Furthermore, we will actively engage with and learn from stakeholders to support the uptake of our newly generated evidence base. Our project will focus on South Asia and Africa, where maternal and newborn mortality rates are the highest worldwide, where 75% of global childhood deaths occur, and where progress towards MDG4 and 5 is off-track. We will use data from 6 demographic surveillance sites in India, Nepal, Bangladesh and Malawi in which delivery outcomes are prospectively followed up for a combined population of over 2 million. Newborn and maternal deaths are measured in a precise and reliable way. Information on birth outcomes will be combined with data on socio-economic background, health care use and home care practices, to analyse inequalities in maternal and newborn mortality. Second, we will use data from randomized controlled trials (RCTs), the gold standard to evaluate interventions, to evaluate the impact of participatory women's groups on socio-economic inequalities in newborn mortality. The women's groups meet monthly, facilitated by a local woman, to identify and prioritise maternal and newborn health problems in the community, select strategies to address them, and implement and evaluate the strategies. Using data from our surveillance systems, we will analyse whether the women's groups reached poor and otherwise disadvantaged women, and whether the interventions reduced socio-economic inequalities in newborn mortality. Qualitative data will be collected to provide an in-depth understanding of the barriers to health care use and safe home care practices, and barriers to women's group attendance among poor and disadvantaged women. Building on strong collaborations between the project partners in the UK, Nepal, India, Bangladesh, Malawi and the Netherlands, our network of international experts will combine cutting-edge research with in-depth field experience and a high profile in policy making. Our multidisciplinary team will use theories and methods from sociology, social anthropology, economics and health sciences, to generate robust evidence to support equitable achievement of the MDGs.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH