Impact of Oportunidades on Skilled Attendance at Delivery in Rural Areas

Oportunidades only modestly increased the use of skilled attendants at the time of delivery among poor women in rural areas of Mexico—more by women who’d previously given birth.


A substantial proportion of maternal deaths in developing countries occur at the time of delivery. Labor attendance by skilled personnel can be an effective way to reduce maternal deaths and raise the chances of newborn survival. However, women in rural areas are less likely to have access to quality medical services, particularly at the time of their delivery. In Mexico, Oportunidades (previously called PROGRESA), a large-scale conditional cash transfer program, includes a health component that targets poor women in rural areas. Enrollment for the program was determined by an estimated poverty score. The program provides pregnancy and delivery care for enrolled women and offers a series of educational talks on family planning, prenatal and newborn care, as well as access to a trained professional during childbirth. This paper assesses the impact of Oportunidades on the utilization of skilled attendants at delivery by women in rural areas.


At best, Oportunidades only modestly increased the use of skilled attendants at the time of delivery among poor women in rural areas. While women with more schooling were 21.6% more likely and women who spoke an indigenous language were 15.3% less likely to have a skilled attendance at the time of delivery, the researchers found:

  • Having a child before enrollment in the program increased the likelihood that a woman would use a skilled attendant for her next childbirth.
  • The program did not have an effect on women who had their first child after enrollment.

At the launch of the Oportunidades program, eligible rural communities were randomized into treatment and control groups. Households in the treatment group started receiving the program in 1998, while the control group was phased into the program in 1999. A baseline survey was conducted in 1997, and several rounds of follow up surveys were conducted from 1998 through 2002.

The analysis in this study includes only households in which at least one woman reported a birth in the 1998 or 2000 rounds of the survey. The baseline information in this analysis includes births that occurred between January 1996 and July 1997. The follow up data captures information for births that occurred between January 1998 and July 1999. The analysis sample includes 3,280 households with women who reported births at baseline and 2,715 households with women reporting births at follow-up.

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