Trends in ethnic disparities in reproductive, maternal, neonatal and child health interventions and the role of social investment and inclusive policies: a mixed-methods study in Ecuador, 2004-2018

Introduction Ethnic disparities in reproductive, maternal, neonatal and child health (RMNCH) persist in Latin America, rooted in structural racism and colonial legacies. Evidence on the temporal evolution of these disparities and the impact of policies targeting Indigenous populations remains limited.

Following the 2000 economic crisis, Ecuador showed the region's largest ethnic gaps in intervention coverage and social determinants. Since 2008, inclusion policies have advanced.

This study analysed trends in RMNCH coverage, social determinants and their potential association with policies and strategies over 14 years. Methods Using a mixed-methods design, we analysed three nationally representative surveys (2004, 2012 and 2018) to assess changes in social determinants and the coverage of six RMNCH services; defined as the proportion of women and children receiving essential health services across the continuum of care, including family planning, antenatal care, skilled birth attendance and child immunisation, stratified by ethnicity (Indigenous women and children, Afro-Ecuadorian populations and Mestizo and White populations).

We estimated absolute inequality measures and adjusted coverage ratios using Poisson regression models.