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Equity of skilled delivery care in developing countries: financing and policy determinants

Date: Poster sessions
Source: Forum 11
Authors: Margaret Elizabeth Kruk, Assistant Research Scientist, Health Management and Policy, University of Michigan School of Public Health, USA
with Marta Prescott and Sandro Galea


Countries with higher spending on health have greater overall utilization of maternal health services including skilled birth attendants (doctors, nurses, or midwives). However, it is possible that greater overall utilization of attendants is driven by disproportionate utilization by the rich, at the expense of the poor. This study examined the financing and policy determinants of more equitable utilization of skilled birth attendants in developing countries.

Data from Demographic and Health Surveys carried out in 45 developing countries and disaggregated by wealth quintile were used. Multivariable regression analyses were used to assess the joint effect of higher health care expenditures, a redistributive policy environment (as measured by the distribution of fifth-grade completion among reproductive-aged women in the survey), and overall national educational attainment.

The results of this study indicate that poor/rich equity in the utilization of skilled birth attendants was greater when health expenditures rose in concert with a more redistributive policy environment, at any given level of national educational attainment. Thus, this study suggests that higher health care expenditures need to be accompanied by redistributive policies to yield more equitable access to skilled birth attendants for the poorest women in developing countries.