The Millennium Development Goals (MDGs) were established in 2000 in a declaration adopted unanimously by the member countries of the United Nations to focus resources and efforts toward the critical global poverty, health, and sustainability problems (http://millenniumindicators.un.org/unsd/mdg/Default.aspx). The MDGs set numerical targets to be achieved by 2015 and use socioeconomic, environmental, nutritional, and health indicators to monitor progress toward these targets. There are concerns that the progress toward some of the health-related MDGs has been slow in many countries, making it very difficult to achieve them by the target date.^1-3 A crucial question for efficient allocation of resources is whether some interventions may help achieve targets related to multiple MDGs, or whether additional and/or separate interventions are needed.

Brazil's large socioeconomic inequalities together with the increase in neonatal mortality jeopardize the MDG-4 child mortality target by 2015. We measured inequality trends in neonatal and under five mortality across municipalities characterized by their socio-economic status in a period where major pro poor policies were implemented in Brazil to infer whether policies and interventions in newborn and child health have been successful in reaching the poor as well as the better off. Using data from the 5,507 municipalities in 1991 and 2000, we developed accurate estimates of neonatal mortality at municipality level and used these data to investigate inequality trends in neonatal and under five mortality across municipalities characterized by socio-economic status. Child health policies and interventions have been more effective in reaching the better off than the worst off. Reduction of under five mortality at national level has been achieved by reducing the level of under five mortality among the better off. Poor municipalities suffer from worse newborn and child health than richer municipalities and the poor/rich gaps have increased. Our analysis highlights the importance of monitoring progress on MDGs at sub-national level and measuring inequality gaps to accurately target health and inter-sectoral policies. Further efforts are required to improve the measurement and monitoring of trends in neonatal and under five mortality at sub-national level, particularly in developing countries and countries with large socioeconomic inequalities.

Both the quantity and the distribution of health workers in a country are fundamental for assuring equitable access to health services. Using the case of Brazil, we measure changes in inequalities in the distribution of the health workforce and account for the sources of inequalities at sub-national level to identify whether policies have been effective in decreasing inequalities and increasing the density of health workers in the poorest areas between 1991 and 2005. With data from Datasus 2005 and the 1991 and 2000 Census we measure the Gini and the Theil T across the 4,267 Brazilian Minimum Comparable Areas (MCA) for 1991, 2000 and 2005 to investigate changes in inequalities in the densities of physicians; nurse professionals; nurse associates; and community health workers by states, poverty quintiles and urban-rural stratum to account for the sources of inequalities. We find that inequalities have increased over time and that physicians and nurse professionals are the categories of health workers, which are more unequally distributed across MCA. The poorest states experience the highest shortage of health workers (below the national average) and have the highest inequalities in the distribution of physicians plus nurse professionals (above the national average) in the three years. Most of the staff in poor areas are unskilled health workers. Most of the overall inequalities in the distribution of health workers across MCA are due to inequalities within states, poverty quintiles and rural-urban stratum. This study highlights some critical issues in terms of the geographical distribution of health workers, which are accessible to the poor and the new methods have given new insights to identify critical geographical areas in Brazil. Eliminating the gap in the health workforce would require policies and interventions to be conducted at the state level focused in poor and rural areas.

Background Despite the realized importance of unsafe abortion as a global health problem, reliable data are difficult to obtain, especially in countries where abortion is illegal. Estimates for most developing countries are based on limited and incomplete sources of data. In Mexico, studies have been undertaken to improve estimates of induced abortion but the determinants of unsafe abortion have not been explored. Methods We analysed data from the 2006 Mexican National Demographic Survey. The sample comprises 14 859 reported pregnancies in women between 15 and 55 years old, of which 966 report having had an abortion in the 5 years preceding the survey. We use logistic regression to explore the relationship between unsafe abortion and various socio-economic and demographic characteristics. Findings We estimate that 44% of abortions have been induced and 16.5% of those were unsafe. We find three variables to be positively and significantly associated with the probability of having an induced abortion: (1) whether the woman reported that the pregnancy was mistimed (OR = 4.5, 95% CI = 1.95–10.95); (2) whether the woman reported that the pregnancy was unwanted (OR = 2.86, 95% CI = −1.40–5.88); and (3) if the woman had three or more children at the time of the abortion (OR = 3.73, 95% CI = 1.20–11.65). There is a steep socio-economic gradient in the probability of having an unsafe abortion: poorer women are more likely to have an unsafe abortion than richer women (OR = 2.48, 95% CI = 1.09–5.63); women with 6–9 years of education (OR = 0.30, 95% CI = 0.11–0.81) and with more than 13 years of education are less likely to have an unsafe abortion (OR = 0.065, 95% CI = 0.01–0.43), and women with indigenous origin are more likely to have an unsafe abortion (OR = 5.44, 95% CI = 1.91–15.51). Thus, the probability for poor women with less than 5 years of education and indigenous origin is nine times higher compared with rich, educated and not indigenous women. We also find marked geographical inequities as women living in the poorest states have a higher risk of having an unsafe abortion. Interpretation This analysis has explored the determinants of unsafe abortion and has demonstrated that there are large socio-economic and geographical inequities in unsafe abortions in Mexico. Further efforts are required to improve the measurement and monitoring of trends in unsafe abortions in developing countries.