{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:35:33Z","timestamp":1792427733586,"version":"4.5.0"},"reference-count":91,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019134","name":"Universidad Central del Ecuador","doi-asserted-by":"publisher","award":["S\/N"],"award-info":[{"award-number":["S\/N"]}],"id":[{"id":"10.13039\/100019134","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,17]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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. Through a literature review and temporal graphs, we analysed plans, policies and strategies in health, education and ethnic inclusion during the same period to estimate potential impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>By 2018, Indigenous populations doubled their representation in the highest wealth quintiles (10% to 20%) and increased secondary education attainment (25% to 45%), with slower progress in rural areas. RMNCH coverage, including prenatal care, institutional deliveries and professional-assisted births, rose significantly (27% to 75%) among Indigenous populations. Afro-Ecuadorians also experienced improvements in RMNCH coverage and social determinants, though progress was less pronounced compared with Indigenous groups. Although ethnic gaps persisted, inequalities declined over the study period. These reductions coincided with increased social investment in rural health and education, constitutional recognition of plurinationality, and policies promoting intercultural health practices. However, gaps in monitoring and impact evaluation were evident.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ecuador demonstrates that inclusive and integrated policies, leadership, social participation and sustained social investment can reduce ethnic inequalities, promote the integral development of society and strategies that should be maintained. Temporal studies based on routine surveys are crucial for monitoring the impact of such policies. These findings provide a pre-pandemic benchmark and serve as a reference for countries aiming to improve health outcomes among Indigenous and Afro-descendant populations and advance the Sustainable Development Goals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113756","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T17:35:20Z","timestamp":1775842520000},"page":"e113756","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["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\u20132018"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1597-3812","authenticated-orcid":false,"given":"Paulina","family":"Rios-Quituizaca","sequence":"first","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador, Quito, Pichincha, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8255-2199","authenticated-orcid":false,"given":"Jesus","family":"Endara-Mina","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias Juridicas y Pol\u00edticas, Carrera de Derecho, Universidad Tecnica Particular de Loja, Loja, Ecuador"},{"name":"Coordinaci\u00f3n de Docencia e Investigaci\u00f3n, Hospital Provincial General Pablo Arturo Su\u00e1rez, Quito, Pichincha, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Zanini","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8245-2841","authenticated-orcid":false,"given":"Nancy","family":"Armenta-Paulino","sequence":"additional","affiliation":[{"name":"Departamento de Cirug\u00eda, Ciencias M\u00e9dicas y Sociales, Facultad de Medicina, Universidad de Alcal\u00e1 (Espa\u00f1a), Alcala de Henares, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"2026041010350911000_16.4.e113756.1","doi-asserted-by":"crossref","first-page":"e902","DOI":"10.1016\/S2214-109X(18)30300-0","article-title":"Ethnic group inequalities in coverage with reproductive, maternal and child health interventions: cross-sectional analyses of national surveys in 16 Latin American and Caribbean countries","volume":"6","author":"Mesenburg","year":"2018","journal-title":"Lancet Glob Health"},{"key":"2026041010350911000_16.4.e113756.2","first-page":"96","article-title":"Assessing equitable care for Indigenous and Afrodescendant women in Latin America","volume":"38","author":"Castro","year":"2015","journal-title":"Rev Panam Salud Publica"},{"key":"2026041010350911000_16.4.e113756.3","unstructured":"Bello A , Rangel M . 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