Bulletin of the World Health Organization

Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward

Steven A Harvey, Yudy Carla Wong Blandón, Affette McCaw-Binns, Ivette Sandino, Luis Urbina, César Rodríguez, Ivonne Gómez, Patricio Ayabaca, Sabou Djibrina, the Nicaraguan maternal and neonatal health quality improvement group

Volume 85, Number 10, October 2007, 783-790

Table 1. Maternal health characteristics of study countries

Country WHO-estimatedMMRa % births occurring in a health facilityb % births assisted by a skilled attendantb Attendant most likely to assist at in-facility delivery
Benin 850 76.0 72.9 Midwife
Ecuador 130 78.5c 74.1c Medical resident or intern
Jamaica 87 95.2 96.5 Midwives (85%), doctors (15%)
Nicaragua 230 66.3 66.9 Medical resident or intern
Rwanda 1400 26.5 31.3 Nurse, nursing assistant

MMR, maternal mortality ratio.a MMR is defined as the number of maternal deaths per 100 000 live births. Source: Maternal mortality in 2000: estimates developed by WHO, UNICEF and UNFPA. Geneva: WHO; 2003.b Statistics from: Benin–2001 DHS; Ecuador–2004 ENDEMAIN; Jamaica–Register General’s Department. Vital Statistics Report, 2001, Twickenham Park: 2003; Nicaragua–2001 DHS; Rwanda–2000 DHS.c In Ecuador, the birth percentages represent two different time intervals. Percentage of births occurring in a health facility takes account of all births from January 2002 to the time of the survey (n = 2798). Percentage of births assisted by a skilled attendant takes account of all births from January 1999 to the time of the survey (n = 6140).

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