While several indicators for reproductive health have improved for entire populations, few analyses are available for
trends over time in the gaps between the poor and the rich. This paper tracks improvements in the equitable distribution
of reproductive health indicators according to wealth quintiles, especially for contraceptive use, in 46 low- and middleincome
countries based on national population-based surveys conducted between 1990 and 2013. It focuses on the
gaps between the poorest and richest quintiles in the earliest and latest survey rounds across a number of reproductive
health indicators related to family planning, fertility desires, antenatal care, and infant and child mortality, as well as on
improvements in the absolute levels of contraceptive use by the poorest quintile. Gap changes were decomposed to show
how the gaps can either diminish or grow due to either the bottom or top quintile, or both. In addition, bivariate
correlation analysis was conducted to examine the relationship of the gaps, and of contraceptive use by the poor, to
national family planning program efforts. Overall, the gaps between the poorest and richest have narrowed, due
primarily to faster improvements among the poor than the rich. For example, the gap between the richest and poorest in
the modern contraceptive prevalence rate has declined by 25%, from a 20.4 percentage point difference to a 15.4 point
difference. And the gap has decreased more where family planning programs have been stronger. Across most of
18 other reproductive health indicators, the gaps have also been narrowing. For instance, the poor-rich gap for
antenatal care decreased by over a third, from a difference of 30.7 percentage points to 19.6 percentage points. Gaps
in infant and child mortality also have declined by about one-third. The pattern for contraceptive use in sub-Saharan
Africa, however, has been mixed, with the gap actually increasing in some countries with strong programs. This disparity
may largely reflect that family planning in the region is generally at an earlier stage in its history, and so programs may
initially be reaching better-off clients, especially in urban areas. To promote additional equity, programs should
emphasize efforts to increase access to voluntary family planning services to the least well-off, including those in rural
and peri-urban areas.