Socioeconomic inequalities in the coverage of reproductive, maternal, neonatal, and child health (RMNCH) interventions have been frequently described in global reports, but little is known about how inequalities vary across indicators in low- and middle-income countries (LMICs).

We performed a cross-sectional analysis using national surveys from LMICs. We identified the most recently conducted survey from the period 2010-2019 for 36 countries containing data for a preselected set of 18 RMNCH interventions. Twenty-one countries also had information on two common malaria interventions.

We classified interventions into four groups according to their primary delivery channels: health facility based, community based, environmental, and culturally driven. Socioeconomic inequality was measured through the slope index of inequality (SII), akin to coverage differences among wealthy and poor households, and the concentration index (CIX), akin to ratios of coverage levels among wealthy and poor households.

We observed higher coverage levels among wealthier households than poor households for most interventions in most countries, except for two breastfeeding indicators showing higher coverage for poor households than wealthy households. Environmental interventions were the most unequal, especially use of clean fuels, followed by primarily health facility based interventions, e.g. institutional childbirth. In contrast, primarily community based interventions, including anti-malaria interventions, were the most equitably distributed.

Community interventions tend to be more equitably distributed than health facility based or environmental interventions. Policymakers need to learn from community based interventions in order to promote more equitable access to all RMNCH interventions.

Link to access the full text: Lancet Global Health