Ethiopia, India, and Nigeria have made progress in tackling serious maternal and infant health care problems, according to a study published Monday in the Canadian Medical Association Journal.

These three countries have an especially high burden of maternal and infant health issues, according to the report, and although the countries have made progress against ensuring health care access, underlying inequities still remain.

The study took place in four regions of Ethiopia (Oromia, Tigray, Amhara, and Southern Nations Nationalities and Peoples); the state of Uttar Pradesh, India; and Gombe State, Nigeria, in 2012 and 2015 — chosen because they represent rural, impoverished populations that experience high maternal and neonatal deaths.

“Despite progress toward meeting the Sustainable Development Goals, a large burden of maternal and neonatal mortality persists for the most vulnerable people in rural areas,” the report states.

In turn, researchers assessed coverage, coverage change, and inequity for eight maternal and newborn health care indicators — from the percentages of women who give birth in health care facilities to the birth attendant’s use of gloves — in the three countries.

In Ethiopia, the percentage of women who had at least four antenatal visits almost doubled — from 22% to 39%. The percentage of women who delivered in a facility nearly tripled from from 15% to 43%.

In India, there was a slight increase in women who delivered in a facility from 76% to 81%. Postnatal care for the mother also increased from 54% to 63%.

In Nigeria, breastfeeding initiation within one hour after birth increased from 40% to 49% and hygienic umbilical cord care practices increased from 26% to 45%.

While the improvements are notable, researchers noted their study has "both an optimistic and a pessimistic interpretation" because families from all socioeconomic status groups benefited, but inequities persisted.

“Addressing inequities in access to and quality of health care is a priority now more than ever, as the poorest members of communities continue to bear the largest burden of ill health and consistently receive lower-quality care,” the report states.

In order to improve maternal and newborn health, community-based programming was prioritized in all three countries. This included interventions such as training community members to make health visits to families, and offering call centers to provide free health advice, which led to healthier behaviors in communities.

Researchers credited these community-based interventions with the improvement in health care. They also called on the need for specific efforts to ensure the most vulnerable members of the population are reached by maternal and newborn care, which they say is a requirement of universal health coverage.