• Cesar G Victora, Aluisio J D Barros, Henrik Axelson, Zulfiqar A Bhutta, Mickey Chopra, Giovanny V A França, Kate Kerber, Betty R Kirkwood, Holly Newby, Carine Ronsmans, and J Ties Boerma.
• Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil. cvictora@gmail.com
• Lancet. 2012 Sep 29;380(9848):1149-56.

BackgroundAchievement of global health goals will require assessment of progress not only nationally but also for population subgroups. We aimed to assess how the magnitude of socioeconomic inequalities in health changes in relation to different rates of national progress in coverage of interventions for the health of mothers and children.MethodsWe assessed coverage in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. We calculated changes in overall coverage of skilled birth attendants, measles vaccination, and a composite coverage index, and examined coverage of a newly introduced intervention, use of insecticide-treated bednets by children. We stratified coverage data according to asset-based wealth quintiles, and calculated relative and absolute indices of inequality. We adjusted correlation analyses for time between surveys and baseline coverage levels.FindingsWe included 35 countries with surveys done an average of 9·1 years apart. Pro-rich inequalities were very prevalent. We noted increased coverage of skilled birth attendants, measles vaccination, and the composite index in most countries from the first to the second survey, while inequalities were reduced. Rapid changes in overall coverage were associated with improved equity. These findings were not due to a capping effect associated with limited scope for improvement in rich households. For use of insecticide-treated bednets, coverage was high for the richest households, but countries making rapid progress did almost as well in reaching the poorest groups. National increases in coverage were primarily driven by how rapidly coverage increased in the poorest quintiles.InterpretationEquity should be accounted for when planning the scaling up of interventions and assessing national progress.FundingBill & Melinda Gates Foundation; World Bank; Governments of Australia, Brazil, Canada, Norway, Sweden, and UK.Copyright © 2012 Elsevier Ltd. All rights reserved.

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