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Equity of skilled birth attendant utilization in developing countries: Financing and policy determinants
Authors: Kruk ME , Prescott MR, Galea S
Source: American Journal of Public Health, 2008 Jan;98(1):142-147.
Topic(s): Antenatal care
Health care utilization
Health equity
Public expenditures
Country: More than one region
  Multiple Regions
Published: JAN 2008
Abstract: Developing countries with higher health care spending have greater overall utilization of maternal health services than do countries with lower spending. However, the rich tend to disproportionately use these services. The authors assessed whether redistributive government policies in the context of higher levels of health spending were associated with more-equitable use of skilled birth attendants (doctors, nurses, or midwives) between rich and poor. The authors used data from Demographic and Health Surveys of 45 developing countries and disaggregated by wealth quintile. Multivariable regression analyses were used to assess the joint effect of higher health care expenditures, the wealth distribution of women's fifth-grade education (a proxy for redistributive policy environment within the central government) and the overall proportion of women with fifth-grade education (a proxy for female literacy and an indicator of governments' commitment to girls' education). The authors found that utilization of skilled birth attendants was more equitable when higher health expenditures were accompanied by redistributive education policies. Higher health care expenditures should be accompanied by redistributive policies to reduce the gap in utilization of skilled birth attendants between poorer and richer women in developing countries.