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November 24, 2020
Maternal and child health inequalities among migrants: the case of Haiti and the Dominican Republic
One of the most important intraregional migration routes in the Caribbean region is the flow of Haitian migrants to the Dominican Republic. Reasons include political and economic instability, as well as several natural disasters in Haiti. We assessed how migrant status affects coverage and inequalities in maternal and child health interventions by comparing Haitian migrant women and children with Haitians and Dominicans residing in their respective countries. We evaluated coverage using nine indicators: demand for family planning satisfied with modern methods (DFPSm), antenatal care (ANC4), skilled birth attendance (SBA), child immunization (BCG, measles and DPT3), child case management (oral rehydration salts for diarrhea – ORS – and careseeking for suspected pneumonia – CAREP), and the composite coverage index (CCI). We measured wealth through an asset-based index, divided into tertiles, and established place of residence (rural vs. urban) from country definitions. Data were used from nationally representative surveys performed in Haiti in 2012 and the Dominican Republic in 2014. Haitians showed the lowest coverage for DFPSm, ANC4, SBA, and CAREP, and the highest for ORS, while Haitian migrants had the lowest coverage for DPT3 and ORS, and the highest coverage of CAREP. Dominicans showed the highest coverage for most indicators. The CCI was 79.2% for Dominicans, 69% for Haitian migrants, and 52.6% for Haitians. All groups generally displayed pro-rich and pro-urban inequality patterns. Haitian migrants exhibit higher coverage than Haitians, while lower than Dominicans, highlighting the importance of documenting intraregional migrants’ health status and of stratified analyses to guide the reduction of health inequalities. A full version of this paper is available at: https://iris.paho.org/handle/10665.2/53012