Substantial progress has been made throughout much of the developing world toward improving the proportion of births delivered with the help of medically trained attendants.1 According to an analysis of nationally representative data from 73 developing countries, the estimated proportion of births delivered with assistance from a doctor, nurse or midwife increased from 45% in 1990 to 54% in 2000; increases occurred in every region except Sub-Saharan Africa and Eurasia. Use of skilled attendants within geographic regions differed by mother's age, parity and wealth.

For the study, researchers compiled data from nationally representative surveys (e.g., Demographic and Health Surveys and Multiple Indicator Cluster Health Surveys) and government reports from developing countries. Country-level data were used to estimate the proportions of births attended by a doctor, nurse or midwife in 1990 and 2000. Regional estimates were weighted using United Nations estimates of the numbers of births in each country. Data on the percentage of births delivered with the help of a skilled attendant were available for 73 countries, representing 82% of births in the developing world in 2000.

Overall, the proportion of births in the developing world delivered with the help of skilled attendants rose from 45% to 54% between 1990 and 2000. The greatest proportional increases occurred in Northern Africa (65%) and Southeast Asia (53%). Most of the increases were attributed to more frequent use of doctors: For example, in North Africa, the use of a doctor increased 95% between 1990 and 2000, whereas the use of a nurse or midwife decreased 24% during the same period. The only regions that did not improve over the decade in terms of use of skilled attendants were Sub-Saharan Africa, where use of skilled attendants remained at around 40%, and Eurasia, where attendance decreased by 3% from near-universal coverage.

In further analyses, the researchers found differences in use of skilled birth attendants by certain characteristics of mothers. In Sub-Saharan Africa and Latin America, the proportions of births delivered by skilled attendants were stable among women up to age 29, but decreased steadily with each older age-group. A different pattern emerged for South and Southeast Asia: In those regions, the youngest and the oldest women were least likely to deliver with help from skilled attendants, whereas women aged 20–29 were the most likely. In addition, overall use of skilled attendants decreased with parity: Sixty-three percent of first births were delivered by skilled attendants; that proportion decreased to 37% among sixth or higher order births. Furthermore, the use of skilled birth attendants increased with wealth.

The authors comment that although use of skilled attendants "is far from universal and is lagging in some regions…substantial progress has been made towards achieving the global goal of 90% coverage by 2015. " They suggest that to promote use of skilled attendants, programs targeting older women, poor women and women having higher parity births may be most effective.—J. Rosenberg "


1. Stanton C et al., Skilled care at birth in the developing world: progress to date and strategies for expanding coverage, Journal of Biosocial Sciences, 2007, 39(1): 109–120.