Back to browse results
Inequalities in the coverage of place of delivery and skilled birth attendance: analyses of cross-sectional surveys in 80 low and middle-income countries
Authors: Gary Joseph, Inácio Crochemore Mohnsam da Silva, Fernando C. Wehrmeister, Aluísio J. D. Barros, and Cesar G. Victora
Source: Reproductive Health, 13: 77; DOI: 10.1186/s12978-016-0192-2
Topic(s): Delivery care
Health care utilization
Maternal health
Country: More than one region
  Multiple Regions
Published: JUN 2016
Abstract: Background Having a health worker with midwifery skills present at delivery is one of the key interventions to reduce maternal and newborn mortality. We sought to estimate the frequencies of (a) skilled birth attendant coverage, (b) institutional delivery, and (c) the combination of place of delivery and type of attendant, in LMICs. Methods National surveys (DHS and MICS) performed in 80 LMICs since 2005 were analyzed to estimate these four categories of delivery care. Results were stratified by wealth quintile based on asset indices, and by urban/rural residence. The combination of place of delivery and type of attendant were also calculated for seven world regions. Results The proportion of institutional SBA deliveries was above 90 % in 25 of the 80 countries, and below 40 % in 11 countries. A strong positive correlation between SBA and institutional delivery coverage (rho: 0.97, p <0,001) was observed. Eight countries had over 10 % of home SBA deliveries, and two countries had over 10 % of institutional non-SBA deliveries. Except for South Asia, all regions had over 80 % of urban deliveries in the institutional SBA category, but in rural areas, only two regions (CEE & CIS, Middle East & North Africa) presented average coverage above 80 %. In all regions, institutional SBA deliveries were over 80 % in the richest quintile. Home SBA deliveries were more common in rural than in urban areas, and in the poorest quintiles in all regions. Facility non-SBA deliveries also tended to be more common in rural areas and among the poorest. Conclusion Four different categories of delivery assistance were identified worldwide. Pro-urban and pro-rich inequalities were observed for coverage of institutional SBA deliveries. Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0192-2) contains supplementary material, which is available to authorized users. Keywords: Skilled delivery, Maternal health services, Skilled birth attendance, Birth attendance, Delivery assistance, Low and middle-income countries, Developing countries, Global health