The effects of skilled health attendants on reducing maternal deaths in developing countries: testing the medical model

More than 500 000 women die each year from pregnancy related causes. Ninety-nine percent of these deaths occur in developing countries. This study examines the statistical relationship between maternal deaths and skilled health attendants. A skilled health attendant is a medical doctor, nurse, trained midwife, primary healthcare worker, or trained traditional birth attendant. A cross-national study was conducted using World Bank and United Nations data. A Medical Model was developed and tested using 100 countries identified as developing. The model consisted of the number of medical doctors in the country, number of nurses in the country, and the percentage of births attended by a skilled health attendant; the dependent variable was the maternal mortality ratio. Beta coefficients from multiple regression analysis indicated a strong association between maternal deaths and skilled health attendant. In addition, the Medical Model was capable of explaining 75% of maternal deaths. Future studies should focus on identifying ancillary or midlevel health care professionals, included in the skilled health attendant category, to ascertain their impact on maternal deaths in developing countries. (C) 2002 Elsevier Science Ltd. All rights reserved.