Maternal and neonatal tetanus is a vaccine-preventable disease (with coverage of the infant conferred by maternal immunization during and prior to pregnancy). Thus, maternal tetanus immunization coverage is a key metric for monitoring progress towards, equity in, and sustainability of tetanus elimination.

This study explores the extent of inequalities in maternal tetanus immunization coverage across 76 low- and middle-income countries. We considered four dimensions of inequality as follows wealth, maternal age, maternal education, and area of residence.

We found lower coverage among poorer wealth quintiles, younger mothers, less educated, and in rural areas. Inequalities existed for all dimensions across low- and lower-middle-income countries, and across maternal education and place of residence across upper-middle-income countries.

Though global coverage changed little over the time period 2001–2020, this obscured substantial heterogeneity across countries. Notably, several countries had substantial increases in coverage accompanied by decreases in inequality, highlighting the need for equity considerations in maternal and neonatal tetanus elimination and sustainability efforts.

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