Maternal health interventions: latest situation and change over time
Births attended by skilled health personnel
85 low- and middle-income study countries, DHS and MICS 2005–2013
Almost half of low- and middle-income study countries reported that at least 80% of live births were attended by skilled health personnel; however, there was wide variation in the proportion of attended births across countries. Generally, the proportion of births attended by skilled health personnel was much lower across low-income countries than in middle-income countries. Study countries in the WHO European Region demonstrated little cross-country inequality in the proportion of births attended by skilled health personnel, with complete – or very high – levels of coverage for this intervention across all countries. The proportion of births attended by skilled health personnel in study countries of other regions, however, ranged from less than 12% to nearly 100%.
Latest situation: by economic status
83 low- and middle-income study countries, DHS and MICS 2005–2013
Overall, the proportion of births attended by skilled health personnel increased with rising economic status: poorer subgroups typically experienced lower levels of skilled birth attendance than richer subgroups. This relationship was more pronounced in low-income study countries than in middle-income study countries. In low-income countries, the median coverage for this intervention ranged from 33.7% in the poorest to 89.0% in the richest quintile, whereas in the middle-income countries it ranged from 76.5% in the poorest to 98.1% in the richest quintile. Most study countries (90%) reported coverage of over 80% in the richest quintile, whereas only 30% of study countries reported this level of coverage in the poorest quintile.
The variation in the proportion of births attended by skilled personnel was larger among the poorer quintiles of countries. Taking the group of middle-income study countries as an example, the interquartile range (middle 50% of study country estimates) was 58.9 percentage points in the poorest quintile of households, 26.3 percentage points in the middle quintile and 4.7 percentage points in the richest quintile.
Change over time: by economic status
42 low- and middle-income study countries, DHS and MICS 1995–2004 and 2005–2013
The national proportion of births attended by skilled health personnel increased over the 10-year period between surveys in the majority of study countries. Half of study countries reported an absolute increase in national coverage for this intervention of at least 1 percentage point per year, which translates into a 10 (or more) percentage point increase over 10 years.
Study countries reported variation in the pace of change between the poorest and richest subgroups in the proportion of births attended by skilled health personnel. In more than half of study countries, the annual absolute excess change was positive, reflecting a pro-poor trend of increasing coverage favouring the most disadvantaged.
Considering the pace of change in subgroups alongside change in national averages, about half of study countries reported a desirable situation: improved national average with increases in the poorest quintile outpacing the change in the richest quintile. Several countries reported no change in national coverage and/or in economic-related inequality. For example, in Jordan and Kazakhstan there was no change in either national coverage or in economic-related inequality because these countries reported complete coverage at both time points.
Other key findings: inequality in maternal health interventions
- For all three dimensions of inequality (economic status, education and place of residence), the lowest levels of inequalities were reported for antenatal care coverage (at least one visit), followed by antenatal care coverage (at least four visits), and then births attended by skilled health personnel.
- Half of study countries reported the prevalence of births attended by skilled health personnel to be at least 20 percentage points higher in urban than in rural areas.
- One quarter of study countries reported that antenatal care coverage (at least four visits) was at least twice as high in women with secondary schooling or higher than in women with no education.
- In most study countries, maternal health interventions demonstrated faster improvements – or more favourable changes – in the most-disadvantaged subgroups (the poorest, the least educated and rural residents) over a 10-year period.
For more information about this feature story, including considerations for interpreting the results, please refer to the report State of inequality: reproductive, maternal, newborn and child health.