Did the strategy of skilled attendance at birth reach the poor in Indonesia

This article in the Bulletin of the World Health Organization, assesses whether the strategy of “a midwife in every village” in Indonesia achieved its aim of increasing professional delivery care for the poorest women. Using data from Demographic and Health Surveys from 1986-2002, the article examines trends in the percentage of births attended by a health professional and deliveries via caesarean section. It finds that after the implementation of the village midwife programme, the greatest increases in professional attendance occurred among the poorest two quintiles. In contrast, most of the increase in rates of caesarean section occurred among women in the wealthiest quintile. Rates of caesarean deliveries remained at less than one per cent for the poorest two-fifths of the population, but rose to ten per cent for the wealthiest fifth.

The article concludes that the Indonesian village midwife programme dramatically reduced socioeconomic inequalities in professional attendance at birth, but the gap in access to potentially life-saving emergency obstetric care widened. This underscores the importance of understanding the barriers to accessing emergency obstetric care and the ways of overcoming them, especially among the poor. [adapted from author]