Laurel Hatt
Did the strategy of skilled attendance at birth reach the poor in Indonesia?
Johns Hopkins University
objective assess whether strategy midwife every village indonesia achieved aim increasing professional delivery care poorest womenmethods using pooled demographic health surveys dhs data 19862002 examined trends percentage births attended health professional deliveries via caesarean sectionwe tested effects economic crisis 1997 negative impact indonesias health systemwe used logistic regression allowing timetrend interactions wealth quintile urbanrural residencefindings change rates professional attendance caesarean section programmes full implementation 19861991after 1991 greatest increases professional attendance occurred among poorest two quintiles 11 per year compared 6 per year women middle quintile p 002these patterns persisted economic crisis endedin contrast increase rates caesarean section occurred among women wealthiest quintilerates caesarean deliveries remained less 1 poorest twofifths population rose 10 wealthiest fifth conclusionthe indonesian village midwife programme dramatically reduced socioeconomic inequalities professional attendance birth gap access potentially lifesaving emergency obstetric care widenedthis underscores importance understanding barriers accessing emergency obstetric care ways overcome especially among poor