Trends in delivery care in six countries

Abstract

Increasing the proportion of deliveries with skilled attendants present is being advocated as the most important step in preventing maternal deaths worldwide. The indicator most commonly used as a proxy for skilled attendance at delivery is the percentage of deliveries attended by a health professional which has been selected as one of the Millennium Development Indicators for measuring reductions in maternal mortality. The objective of this study is to provide an in-depth understanding of trends in delivery with a health professional over the last decade across a range of developing countries: Bangladesh Bolivia Ghana Indonesia Malawi and the Philippines. In particular the study analyzes trends in the types of professionals providing services the place of delivery and some composite indicators of skilled attendance. Throughout the report emphasis has been placed on identifying subnational variation in trends by socioeconomic and obstetric characteristics of the women. The proportion of deliveries with a health professional has increased over the last decade in all six countries. The national trends were statistically significant in three countries—Bangladesh Bolivia and Indonesia—with the largest absolute increases in Bolivia and Indonesia. National trends however mask variations between different groups of women. Urban-rural residence economic status (wealth index) parity maternal education and age were all associated with delivery with a health professional. The results suggest that inequities among women of different backgrounds may be increasing emphasizing the importance of subnational analyses to ensure that the women least likely to seek care are not marginalized. (excerpt)