Access to education, however, contributes to birth attendant use, so the optimal scenario in a country combines higher health care expenditures and equitable access policies.

The study analyzed data from Demographic and Health Surveys of 45 developing countries to investigate the extent to which redistributive education policies modify the impact of higher health spending on the utilization of skilled birth attendants among the poorest compared with the least poor women. Data suggests that at any given level of health care spending, women's use of skilled birth attendants varied substantially, depending on the equity of distribution of education.

"This work supports the thesis that higher levels of health expenditure do not automatically mean substantially greater use of skilled birth attendants by poor women," said the study's authors. "Poor women's access to education, which is in the domain of government policy and reflects a redistributive policy environment, is an important influence on improving the equity of access." [From: "Equity of Skilled Birth Attendant Utilization in Developing Countries: Financing and Policy Determinants." Contact: Margaret Kruk, MD, MPH, Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, mkrukumich.edu .]

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American Journal of Public Health