{"id":"https://openalex.org/W7153298564","doi":"https://doi.org/10.1136/bmjopen-2025-113756","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","display_name":"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","publication_year":2026,"publication_date":"2026-04-01","ids":{"openalex":"https://openalex.org/W7153298564","doi":"https://doi.org/10.1136/bmjopen-2025-113756","pmid":"https://pubmed.ncbi.nlm.nih.gov/41962973"},"language":"en","primary_location":{"id":"doi:10.1136/bmjopen-2025-113756","doi":"https://doi.org/10.1136/bmjopen-2025-113756","is_oa":true,"landing_page_url":"https://doi.org/10.1136/bmjopen-2025-113756","pdf_url":"https://bmjopen.bmj.com/content/bmjopen/16/4/e113756.full.pdf","source":{"id":"https://openalex.org/S79054089","display_name":"BMJ Open","issn_l":"2044-6055","issn":["2044-6055"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319945","host_organization_name":"BMJ","host_organization_lineage":["https://openalex.org/P4310319945"],"host_organization_lineage_names":["BMJ"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMJ Open","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://bmjopen.bmj.com/content/bmjopen/16/4/e113756.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5075108559","display_name":"Paulina Bel\u00e9n R\u00edos Quituizaca","orcid":"https://orcid.org/0000-0002-1597-3812","observed_orcids":["https://orcid.org/0000-0002-1597-3812"]},"institutions":[{"id":"https://openalex.org/I141930428","display_name":"Central University of Ecuador","ror":"https://ror.org/010n0x685","country_code":"EC","type":"education","lineage":["https://openalex.org/I141930428"]}],"countries":["EC"],"is_corresponding":true,"raw_author_name":"Paulina Rios-Quituizaca","raw_affiliation_strings":["Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador, Quito, Pichincha, Ecuador"],"raw_orcid":"https://orcid.org/0000-0002-1597-3812","affiliations":[{"raw_affiliation_string":"Facultad de Ciencias M\u00e9dicas, Carrera de Obstetricia, Universidad Central del Ecuador, Quito, Pichincha, Ecuador","institution_ids":["https://openalex.org/I141930428"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5092774089","display_name":"Jes\u00fas Endara-Mina","orcid":"https://orcid.org/0000-0001-8255-2199","observed_orcids":["https://orcid.org/0000-0001-8255-2199"]},"institutions":[{"id":"https://openalex.org/I100205273","display_name":"Universidad T\u00e9cnica Particular de Loja","ror":"https://ror.org/04dvbth24","country_code":"EC","type":"education","lineage":["https://openalex.org/I100205273"]},{"id":"https://openalex.org/I4210122070","display_name":"Ministerio de Salud P\u00fablica","ror":"https://ror.org/02t46gq94","country_code":"EC","type":"government","lineage":["https://openalex.org/I4210122070"]}],"countries":["EC"],"is_corresponding":false,"raw_author_name":"Jesus Endara-Mina","raw_affiliation_strings":["Coordinaci\u00f3n de Docencia e Investigaci\u00f3n, Hospital Provincial General Pablo Arturo Su\u00e1rez, Quito, Pichincha, Ecuador","Facultad de Ciencias Juridicas y Pol\u00edticas, Carrera de Derecho, Universidad Tecnica Particular de Loja, Loja, Ecuador"],"raw_orcid":"https://orcid.org/0000-0001-8255-2199","affiliations":[{"raw_affiliation_string":"Coordinaci\u00f3n de Docencia e Investigaci\u00f3n, Hospital Provincial General Pablo Arturo Su\u00e1rez, Quito, Pichincha, Ecuador","institution_ids":["https://openalex.org/I4210122070"]},{"raw_affiliation_string":"Facultad de Ciencias Juridicas y Pol\u00edticas, Carrera de Derecho, Universidad Tecnica Particular de Loja, Loja, Ecuador","institution_ids":["https://openalex.org/I100205273"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5051128879","display_name":"Leonardo Z. Ferreira","orcid":"https://orcid.org/0000-0001-7843-9345","observed_orcids":["https://orcid.org/0000-0001-7843-9345"]},"institutions":[{"id":"https://openalex.org/I169248161","display_name":"Universidade Federal de Pelotas","ror":"https://ror.org/05msy9z54","country_code":"BR","type":"education","lineage":["https://openalex.org/I169248161"]}],"countries":["BR"],"is_corresponding":false,"raw_author_name":"Leonardo Zanini Ferreira","raw_affiliation_strings":["Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil","institution_ids":["https://openalex.org/I169248161"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5048907072","display_name":"Nancy Armenta-Paulino","orcid":"https://orcid.org/0000-0001-8245-2841","observed_orcids":["https://orcid.org/0000-0001-8245-2841"]},"institutions":[{"id":"https://openalex.org/I189268942","display_name":"Universidad de Alcal\u00e1","ror":"https://ror.org/04pmn0e78","country_code":"ES","type":"education","lineage":["https://openalex.org/I189268942"]}],"countries":["ES"],"is_corresponding":false,"raw_author_name":"Nancy Armenta-Paulino","raw_affiliation_strings":["Departamento de Cirug\u00eda, Ciencias M\u00e9dicas y Sociales, Facultad de Medicina, Universidad de Alcal\u00e1 (Espa\u00f1a), Alcala de Henares, Spain"],"raw_orcid":"https://orcid.org/0000-0001-8245-2841","affiliations":[{"raw_affiliation_string":"Departamento de Cirug\u00eda, Ciencias M\u00e9dicas y Sociales, Facultad de Medicina, Universidad de Alcal\u00e1 (Espa\u00f1a), Alcala de Henares, Spain","institution_ids":["https://openalex.org/I189268942"]}]}],"institutions":[],"countries_distinct_count":3,"institutions_distinct_count":5,"corresponding_author_ids":["https://openalex.org/A5075108559"],"corresponding_institution_ids":["https://openalex.org/I141930428"],"apc_list":{"value":1500,"currency":"GBP","value_usd":1839},"apc_paid":{"value":1500,"currency":"GBP","value_usd":1839},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.20999677,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"16","issue":"4","first_page":"e113756","last_page":"e113756"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10209","display_name":"Global Maternal and Child Health","score":0.9067000150680542,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10209","display_name":"Global Maternal and Child Health","score":0.9067000150680542,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13633","display_name":"Public Health and Social Inequalities","score":0.05260000005364418,"subfield":{"id":"https://openalex.org/subfields/3306","display_name":"Health"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12741","display_name":"Maternal and Neonatal Healthcare","score":0.02319999970495701,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/ethnic-disparities","display_name":"ethnic disparities","score":0.9399999976158142},{"id":"https://openalex.org/keywords/indigenous-peoples","display_name":"indigenous peoples","score":0.8040000200271606},{"id":"https://openalex.org/keywords/afro-ecuadorians","display_name":"Afro-Ecuadorians","score":0.9229999780654907},{"id":"https://openalex.org/keywords/social-determinants-of-health","display_name":"social determinants of health","score":0.859000027179718},{"id":"https://openalex.org/keywords/social-investment","display_name":"social investment","score":0.796999990940094},{"id":"https://openalex.org/keywords/inclusive-health-policy","display_name":"inclusive health policy","score":0.7979999780654907},{"id":"https://openalex.org/keywords/family-planning","display_name":"family planning","score":0.5040000081062317},{"id":"https://openalex.org/keywords/prenatal-care","display_name":"prenatal care","score":0.968999981880188},{"id":"https://openalex.org/keywords/skilled-birth-attendance","display_name":"skilled birth attendance","score":0.9950000047683716},{"id":"https://openalex.org/keywords/childhood-immunization","display_name":"childhood immunization","score":0.949999988079071},{"id":"https://openalex.org/keywords/rural-health","display_name":"rural health","score":0.5709999799728394},{"id":"https://openalex.org/keywords/educational-inequality","display_name":"educational inequality","score":0.5370000004768372},{"id":"https://openalex.org/keywords/structural-racism","display_name":"structural racism","score":0.652999997138977},{"id":"https://openalex.org/keywords/plurinationalism","display_name":"plurinationalism","score":0.7649999856948853},{"id":"https://openalex.org/keywords/ecuador","display_name":"Ecuador","score":0.6809999942779541},{"id":"https://openalex.org/keywords/health-equity","display_name":"health equity","score":0.43299999833106995},{"id":"https://openalex.org/keywords/policy-impact-assessment","display_name":"policy impact assessment","score":0.414000004529953}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.6876999735832214},{"id":"https://openalex.org/C137403100","wikidata":"https://www.wikidata.org/wiki/Q41710","display_name":"Ethnic group","level":2,"score":0.6202999949455261},{"id":"https://openalex.org/C55958113","wikidata":"https://www.wikidata.org/wiki/Q169480","display_name":"Indigenous","level":2,"score":0.5551000237464905},{"id":"https://openalex.org/C2778173179","wikidata":"https://www.wikidata.org/wiki/Q25339289","display_name":"Attendance","level":2,"score":0.5419999957084656},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.5148000121116638},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.4307999908924103},{"id":"https://openalex.org/C2250968","wikidata":"https://www.wikidata.org/wiki/Q1512929","display_name":"Health equity","level":3,"score":0.4246000051498413},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.41510000824928284},{"id":"https://openalex.org/C78491826","wikidata":"https://www.wikidata.org/wiki/Q3045352","display_name":"Social determinants of health","level":3,"score":0.41260001063346863},{"id":"https://openalex.org/C73269764","wikidata":"https://www.wikidata.org/wiki/Q954529","display_name":"Poisson regression","level":3,"score":0.4101000130176544},{"id":"https://openalex.org/C165148211","wikidata":"https://www.wikidata.org/wiki/Q5431887","display_name":"Social inequality","level":3,"score":0.40070000290870667},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.375900000333786},{"id":"https://openalex.org/C2780877353","wikidata":"https://www.wikidata.org/wiki/Q2518253","display_name":"Health services research","level":3,"score":0.3702999949455261},{"id":"https://openalex.org/C142164852","wikidata":"https://www.wikidata.org/wiki/Q2143884","display_name":"Social medicine","level":3,"score":0.35260000824928284},{"id":"https://openalex.org/C2779297142","wikidata":"https://www.wikidata.org/wiki/Q3276412","display_name":"Educational attainment","level":2,"score":0.35089999437332153},{"id":"https://openalex.org/C45555294","wikidata":"https://www.wikidata.org/wiki/Q28113351","display_name":"Inequality","level":2,"score":0.3499999940395355},{"id":"https://openalex.org/C109359841","wikidata":"https://www.wikidata.org/wiki/Q728944","display_name":"Inclusion (mineral)","level":2,"score":0.32499998807907104},{"id":"https://openalex.org/C2777082460","wikidata":"https://www.wikidata.org/wiki/Q3377398","display_name":"Early childhood","level":2,"score":0.323199987411499},{"id":"https://openalex.org/C47344431","wikidata":"https://www.wikidata.org/wiki/Q1519812","display_name":"Health policy","level":3,"score":0.31769999861717224},{"id":"https://openalex.org/C29719523","wikidata":"https://www.wikidata.org/wiki/Q7551096","display_name":"Social epidemiology","level":4,"score":0.3174000084400177},{"id":"https://openalex.org/C158886217","wikidata":"https://www.wikidata.org/wiki/Q16799549","display_name":"Latin Americans","level":2,"score":0.31690001487731934},{"id":"https://openalex.org/C104977270","wikidata":"https://www.wikidata.org/wiki/Q16000306","display_name":"Race and health","level":4,"score":0.3142000138759613},{"id":"https://openalex.org/C2778149918","wikidata":"https://www.wikidata.org/wiki/Q3291156","display_name":"Population health","level":3,"score":0.3125},{"id":"https://openalex.org/C109260823","wikidata":"https://www.wikidata.org/wiki/Q407784","display_name":"Child development","level":2,"score":0.3068000078201294},{"id":"https://openalex.org/C2908807203","wikidata":"https://www.wikidata.org/wiki/Q7994501","display_name":"White British","level":3,"score":0.30559998750686646},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.3034999966621399},{"id":"https://openalex.org/C2780892066","wikidata":"https://www.wikidata.org/wiki/Q1591167","display_name":"Household income","level":2,"score":0.2969000041484833},{"id":"https://openalex.org/C2992125907","wikidata":"https://www.wikidata.org/wiki/Q1741837","display_name":"Child health","level":2,"score":0.2957000136375427},{"id":"https://openalex.org/C139838865","wikidata":"https://www.wikidata.org/wiki/Q8461","display_name":"Racism","level":2,"score":0.28450000286102295},{"id":"https://openalex.org/C147077947","wikidata":"https://www.wikidata.org/wiki/Q1515895","display_name":"Socioeconomic status","level":3,"score":0.27559998631477356},{"id":"https://openalex.org/C19159745","wikidata":"https://www.wikidata.org/wiki/Q828395","display_name":"Social policy","level":2,"score":0.2687000036239624},{"id":"https://openalex.org/C110888244","wikidata":"https://www.wikidata.org/wiki/Q187588","display_name":"Social class","level":2,"score":0.2637999951839447},{"id":"https://openalex.org/C2781316041","wikidata":"https://www.wikidata.org/wiki/Q1230584","display_name":"Diversity (politics)","level":2,"score":0.25429999828338623},{"id":"https://openalex.org/C53059260","wikidata":"https://www.wikidata.org/wiki/Q374758","display_name":"Multilevel model","level":2,"score":0.2515000104904175}],"mesh":[{"descriptor_ui":"D000067576","descriptor_name":"Child Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D000067576","descriptor_name":"Child Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D000068097","descriptor_name":"Maternal Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D000068097","descriptor_name":"Maternal Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D000068101","descriptor_name":"Maternal-Child Health Services","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":true},{"descriptor_ui":"D000068101","descriptor_name":"Maternal-Child Health Services","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":true},{"descriptor_ui":"D000068104","descriptor_name":"Infant Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000068104","descriptor_name":"Infant Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000068104","descriptor_name":"Infant Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000068104","descriptor_name":"Infant Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000068104","descriptor_name":"Infant Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000068104","descriptor_name":"Infant Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000093862","descriptor_name":"Socioeconomic Disparities in Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000093862","descriptor_name":"Socioeconomic Disparities in Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000093862","descriptor_name":"Socioeconomic Disparities in Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000093862","descriptor_name":"Socioeconomic Disparities in Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000094860","descriptor_name":"South American People","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D000094860","descriptor_name":"South American People","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D000094860","descriptor_name":"South American People","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002648","descriptor_name":"Child","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002648","descriptor_name":"Child","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002648","descriptor_name":"Child","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002648","descriptor_name":"Child","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002648","descriptor_name":"Child","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002648","descriptor_name":"Child","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D004484","descriptor_name":"Ecuador","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D004484","descriptor_name":"Ecuador","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D004484","descriptor_name":"Ecuador","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D004484","descriptor_name":"Ecuador","qualifier_ui":"Q000208","qualifier_name":"ethnology","is_major_topic":false},{"descriptor_ui":"D004484","descriptor_name":"Ecuador","qualifier_ui":"Q000208","qualifier_name":"ethnology","is_major_topic":false},{"descriptor_ui":"D004484","descriptor_name":"Ecuador","qualifier_ui":"Q000208","qualifier_name":"ethnology","is_major_topic":false},{"descriptor_ui":"D005006","descriptor_name":"Ethnicity","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D005006","descriptor_name":"Ethnicity","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D005006","descriptor_name":"Ethnicity","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D005006","descriptor_name":"Ethnicity","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D005006","descriptor_name":"Ethnicity","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D005006","descriptor_name":"Ethnicity","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006291","descriptor_name":"Health Policy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D006291","descriptor_name":"Health Policy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D006291","descriptor_name":"Health Policy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D006291","descriptor_name":"Health Policy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D006291","descriptor_name":"Health Policy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D006291","descriptor_name":"Health Policy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007223","descriptor_name":"Infant","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007223","descriptor_name":"Infant","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007223","descriptor_name":"Infant","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007223","descriptor_name":"Infant","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007223","descriptor_name":"Infant","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007223","descriptor_name":"Infant","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007231","descriptor_name":"Infant, Newborn","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007231","descriptor_name":"Infant, Newborn","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007231","descriptor_name":"Infant, Newborn","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007231","descriptor_name":"Infant, Newborn","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007231","descriptor_name":"Infant, Newborn","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007231","descriptor_name":"Infant, Newborn","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011247","descriptor_name":"Pregnancy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011247","descriptor_name":"Pregnancy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011247","descriptor_name":"Pregnancy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011247","descriptor_name":"Pregnancy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011247","descriptor_name":"Pregnancy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011247","descriptor_name":"Pregnancy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000208","qualifier_name":"ethnology","is_major_topic":true},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000208","qualifier_name":"ethnology","is_major_topic":true},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000208","qualifier_name":"ethnology","is_major_topic":true},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000208","qualifier_name":"ethnology","is_major_topic":true},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000208","qualifier_name":"ethnology","is_major_topic":true},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000208","qualifier_name":"ethnology","is_major_topic":true},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":true},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":true},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":true},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":true},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":true},{"descriptor_ui":"D054625","descriptor_name":"Healthcare Disparities","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":true},{"descriptor_ui":"D060728","descriptor_name":"Reproductive Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D060728","descriptor_name":"Reproductive Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D060728","descriptor_name":"Reproductive Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D060728","descriptor_name":"Reproductive Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D064890","descriptor_name":"Social Determinants of Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D064890","descriptor_name":"Social Determinants of Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D064890","descriptor_name":"Social Determinants of Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D064890","descriptor_name":"Social Determinants of Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D064890","descriptor_name":"Social Determinants of Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D064890","descriptor_name":"Social Determinants of Health","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":4,"locations":[{"id":"doi:10.1136/bmjopen-2025-113756","doi":"https://doi.org/10.1136/bmjopen-2025-113756","is_oa":true,"landing_page_url":"https://doi.org/10.1136/bmjopen-2025-113756","pdf_url":"https://bmjopen.bmj.com/content/bmjopen/16/4/e113756.full.pdf","source":{"id":"https://openalex.org/S79054089","display_name":"BMJ Open","issn_l":"2044-6055","issn":["2044-6055"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319945","host_organization_name":"BMJ","host_organization_lineage":["https://openalex.org/P4310319945"],"host_organization_lineage_names":["BMJ"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMJ Open","raw_type":"journal-article"},{"id":"pmid:41962973","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41962973","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMJ open","raw_type":"Journal Article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13084814","doi":null,"is_oa":true,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41962973/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13084814/pdf/bmjopen-16-4.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"BMJ Open","raw_type":"Text"},{"id":"pmh:oai:doaj.org/article:3598cfa6bf46429499dbbb3ec59c7d3e","doi":null,"is_oa":true,"landing_page_url":"https://doaj.org/article/3598cfa6bf46429499dbbb3ec59c7d3e","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"BMJ Open, Vol 16, Iss 4 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1136/bmjopen-2025-113756","doi":"https://doi.org/10.1136/bmjopen-2025-113756","is_oa":true,"landing_page_url":"https://doi.org/10.1136/bmjopen-2025-113756","pdf_url":"https://bmjopen.bmj.com/content/bmjopen/16/4/e113756.full.pdf","source":{"id":"https://openalex.org/S79054089","display_name":"BMJ Open","issn_l":"2044-6055","issn":["2044-6055"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310319945","host_organization_name":"BMJ","host_organization_lineage":["https://openalex.org/P4310319945"],"host_organization_lineage_names":["BMJ"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMJ Open","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/10","score":1.0,"display_name":"Reduced inequalities"},{"id":"https://metadata.un.org/sdg/3","score":0.9391000270843506,"display_name":"Good health and well-being"}],"sustainable_development_goals_aurora":[{"id":"https://metadata.un.org/sdg/10","score":0.792281448841095,"display_name":"Reduced inequalities"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[{"id":"https://openalex.org/F4320318744","display_name":"Universidad Central del Ecuador","ror":"https://ror.org/010n0x685"},{"id":"https://openalex.org/F4320327255","display_name":"Pontificia Universidad Cat\u00f3lica del Ecuador","ror":"https://ror.org/02qztda51"}],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7153298564.pdf","grobid_xml":"https://content.openalex.org/works/W7153298564.grobid-xml"},"referenced_works_count":32,"referenced_works":["https://openalex.org/W2009022707","https://openalex.org/W2064957544","https://openalex.org/W2071808384","https://openalex.org/W2120843308","https://openalex.org/W2123966392","https://openalex.org/W2399792047","https://openalex.org/W2499736776","https://openalex.org/W2795205038","https://openalex.org/W2795579692","https://openalex.org/W2813010704","https://openalex.org/W2884297047","https://openalex.org/W2891378911","https://openalex.org/W2899288768","https://openalex.org/W2920396159","https://openalex.org/W2947210928","https://openalex.org/W3043153473","https://openalex.org/W3092218295","https://openalex.org/W3122436305","https://openalex.org/W4220679160","https://openalex.org/W4221080901","https://openalex.org/W4226154633","https://openalex.org/W4280610973","https://openalex.org/W4296779621","https://openalex.org/W4366983199","https://openalex.org/W4367312892","https://openalex.org/W4382795583","https://openalex.org/W4387766345","https://openalex.org/W4391784148","https://openalex.org/W4392771967","https://openalex.org/W4396893876","https://openalex.org/W4398131442","https://openalex.org/W4414867689"],"related_works":[],"abstract_inverted_index":{"INTRODUCTION:":[0],"Ethnic":[1],"disparities":[2,29],"in":[3,12,16,52,68,102,180,202,221,246,278,295],"reproductive,":[4],"maternal,":[5],"neonatal":[6],"and":[7,19,30,55,73,79,97,105,118,137,145,149,151,159,171,178,183,210,231,249,281,287,297,307,313,327,354,368,371],"child":[8,138],"health":[9,122,280,291,364],"(RMNCH)":[10],"persist":[11],"Latin":[13],"America,":[14],"rooted":[15],"structural":[17],"racism":[18],"colonial":[20],"legacies.":[21],"Evidence":[22],"on":[23,336],"the":[24,31,41,47,106,114,125,187,203,268,322,343,373],"temporal":[25,172],"evolution":[26],"of":[27,33,108,116,127,285,325,345],"these":[28],"impact":[32,298,344],"policies":[34,61,78,177,288],"targeting":[35],"Indigenous":[36,197,240,259,367],"populations":[37,148,198,370],"remains":[38],"limited.":[39],"Following":[40],"2000":[42],"economic":[43],"crisis,":[44],"Ecuador":[45,303],"showed":[46],"region's":[48],"largest":[49],"ethnic":[50,184,262,319],"gaps":[51,263,294],"intervention":[53],"coverage":[54,107,161,248],"social":[56,71,103,250,276,311,315],"determinants.":[57],"Since":[58],"2008,":[59],"inclusion":[60,185],"have":[62],"advanced.":[63],"This":[64],"study":[65,269],"analysed":[66,90,175],"trends":[67],"RMNCH":[69,110,224,247],"coverage,":[70,225],"determinants":[72,104],"their":[74,200],"potential":[75,192],"association":[76],"with":[77,218,258,274],"strategies":[80,179,328],"over":[81,267],"14":[82],"years.":[83],"METHODS:":[84],"Using":[85],"a":[86,168,351,357],"mixed-methods":[87],"design,":[88],"we":[89,174],"three":[91],"nationally":[92],"representative":[93],"surveys":[94,338],"(2004,":[95],"2012":[96],"2018)":[98],"to":[99,190,208,216,237,362],"assess":[100],"changes":[101],"six":[109],"services;":[111],"defined":[112],"as":[113,356],"proportion":[115],"women":[117,144],"children":[119],"receiving":[120],"essential":[121],"services":[123],"across":[124],"continuum":[126],"care,":[128,133,228],"including":[129,226],"family":[130],"planning,":[131],"antenatal":[132],"skilled":[134],"birth":[135],"attendance":[136],"immunisation,":[139],"stratified":[140],"by":[141],"ethnicity":[142],"(Indigenous":[143],"children,":[146],"Afro-Ecuadorian":[147],"Mestizo":[150],"White":[152],"populations).":[153],"We":[154],"estimated":[155],"absolute":[156],"inequality":[157],"measures":[158],"adjusted":[160],"ratios":[162],"using":[163],"Poisson":[164],"regression":[165],"models.":[166],"Through":[167],"literature":[169],"review":[170],"graphs,":[173],"plans,":[176],"health,":[181],"education":[182,213],"during":[186],"same":[188],"period":[189],"estimate":[191],"impact.":[193],"RESULTS:":[194],"By":[195],"2018,":[196],"doubled":[199],"representation":[201],"highest":[204],"wealth":[205],"quintiles":[206],"(10%":[207],"20%)":[209],"increased":[211,275],"secondary":[212],"attainment":[214],"(25%":[215],"45%),":[217],"slower":[219],"progress":[220,253],"rural":[222,279],"areas.":[223],"prenatal":[227],"institutional":[229],"deliveries":[230],"professional-assisted":[232],"births,":[233],"rose":[234],"significantly":[235],"(27%":[236],"75%)":[238],"among":[239,366],"populations.":[241],"Afro-Ecuadorians":[242],"also":[243],"experienced":[244],"improvements":[245],"determinants,":[251],"though":[252],"was":[254],"less":[255],"pronounced":[256],"compared":[257],"groups.":[260],"Although":[261],"persisted,":[264],"inequalities":[265],"declined":[266],"period.":[270],"These":[271,348],"reductions":[272],"coincided":[273],"investment":[277,316],"education,":[282],"constitutional":[283],"recognition":[284],"plurinationality,":[286],"promoting":[289],"intercultural":[290],"practices.":[292],"However,":[293],"monitoring":[296,342],"evaluation":[299],"were":[300],"evident.":[301],"CONCLUSIONS:":[302],"demonstrates":[304],"that":[305,329],"inclusive":[306],"integrated":[308],"policies,":[309],"leadership,":[310],"participation":[312],"sustained":[314],"can":[317],"reduce":[318],"inequalities,":[320],"promote":[321],"integral":[323],"development":[324],"society":[326],"should":[330],"be":[331],"maintained.":[332],"Temporal":[333],"studies":[334],"based":[335],"routine":[337],"are":[339],"crucial":[340],"for":[341,359],"such":[346],"policies.":[347],"findings":[349],"provide":[350],"pre-pandemic":[352],"benchmark":[353],"serve":[355],"reference":[358],"countries":[360],"aiming":[361],"improve":[363],"outcomes":[365],"Afro-descendant":[369],"advance":[372],"Sustainable":[374],"Development":[375],"Goals.":[376]},"counts_by_year":[],"updated_date":"2026-10-14T16:39:01.820549","created_date":"2026-04-11T00:00:00"}
