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<p>This study shows how deep-rooted inequalities—shaped by where a child is born, their family’s income, and their mother’s education—restrict access to essential services for early development. Using data from the National Survey on Childhood Malnutrition (ENDI), we use the Human Opportunity Index (HOI) and Shapley decomposition to assess disparities in healthcare, water, and sanitation in Ecuador. Although overall averages for services like prenatal care and immunization are high, children with chronic malnutrition (stunting) face much less access and greater inequality. The largest gaps are in access to safely managed drinking water and sanitation, where both coverage and equity remain low, particularly among stunted children. Geographic location is the main predictor of inequality, followed by economic status and maternal education. This study provides transferable insights to inform equitable public health policies in similar contexts worldwide.</p>

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Disentangling disparities in children’s development

  • 期刊论文

  • 发表日期：

    2026年6月30日

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  • Nicolás Acosta-González,
  • Carolina Pérez,
  • Silvio Guerra

摘要

This study shows how deep-rooted inequalities—shaped by where a child is born, their family’s income, and their mother’s education—restrict access to essential services for early development. Using data from the National Survey on Childhood Malnutrition (ENDI), we use the Human Opportunity Index (HOI) and Shapley decomposition to assess disparities in healthcare, water, and sanitation in Ecuador. Although overall averages for services like prenatal care and immunization are high, children with chronic malnutrition (stunting) face much less access and greater inequality. The largest gaps are in access to safely managed drinking water and sanitation, where both coverage and equity remain low, particularly among stunted children. Geographic location is the main predictor of inequality, followed by economic status and maternal education. This study provides transferable insights to inform equitable public health policies in similar contexts worldwide.