Global Health Observatory (GHO)

Births attended by skilled health personnel: inequality by wealth quintile

Situation

Inequality is shown by wealth quintile, reported in 81 low- and middle-income study countries, based on DHS data from births in the three years prior to survey or MICS data from births in the two years prior to survey, 2005–2012.

Overall, skilled birth attendance coverage in low- and middle-income countries demonstrated a gradient across wealth quintiles. Poorer population subgroups reported lower levels of skilled birth attendance coverage than richer population subgroups. The median coverage in the poorest quintiles of study countries is much lower than the median coverage in the richest quintiles (56.3% and 95.7%, respectively).

Overall, middle-income countries reported higher skilled birth attendance coverage than low-income countries. For example, the median coverage reported by the poorest quintiles in middle-income countries was more than 2 times the median coverage in the poorest quintiles in low-income countries (76.2% and 32.5%, respectively).

The variation in coverage levels among countries was greater for poorer quintiles compared to richer quintiles. The interquartile range is 57.4% points and 9.6% points in the poorest and richest quintiles, respectively (light blue areas).

Important considerations when interpreting the results:

  • The data were taken from surveys which were not conducted in the same year in all countries. Data reflect the situation in a country at the time of the survey which, naturally, is subject to change.
  • Estimates are subject to sample variability, typically indicated by confidence intervals. For the sake of readability, only point estimates are shown.

Trends

Changes in inequality are shown by wealth quintile, reported in 34 low- and middle-income study countries, based on DHS data from births in the three years prior to survey or MICS data from births in the two years prior to survey, 1996–2002 and
2006–2012.

Overall, skilled birth attendance coverage tended to increase over time, especially in poorer quintiles. Between 1996–2002 and 2006–2012, the median coverage within the poorest quintiles increased from 26.3% to 45.2%; the median coverage within the richest quintiles increased from 88.8% to 95.5%.

Within the WHO African Region, countries tended to show improved skilled birth attendance coverage in each wealth quintile, with the largest increase in median prevalence reported by the middle quintiles of study countries. Most of the study countries from the WHO African Region demonstrated high coverage in the richest quintile at both time periods (median coverage was 85.6% and 90.8% in first and second periods, respectively).

Important considerations when interpreting the results:

  • For trends, the period between two sequential surveys in each country is usually 10–12 years; however, this period ranges from six to 14 years.
  • Estimates are subject to sample variability, typically indicated by confidence intervals. For the sake of readability, only point estimates are shown.
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