placestats

DTP3 immunisation vs. Skilled birth attendance

Holds up after adjusting for income

Across 174 countries, DTP3 immunisation and Skilled birth attendance rise and fall together at r = +0.61 (on a scale from −1 to +1, where 0 means no link). Comparing only countries with similar income (GDP per person) shrinks it to +0.42 (q = 0.0099, allowing for the many pairs tested). Much of the first figure is that both measures rise with national income, but a moderate positive link remains. Caution: correlation moves sharply once outliers are trimmed.

Comparing countries across the middle half of skilled birth attendance, 86% to 99.7% of births, dtp3 immunisation is better by 6.69% of children aged 12-23 months at the top of that range than the bottom. Comparing only countries with similar national income, the gap is 5.43% of children aged 12-23 months.

Link before adjusting (r)+0.615p = 1.9e-19 · 174 countries
After adjusting for national income+0.422p = 7.0e-9 · likely range [+0.29, +0.54]
p, allowing for regions0.003standard error 0.087 · 7 regions
Check for luck (q)0.010across 12,497 pairs

How to read these.r runs from −1 (one goes up as the other goes down) to +1 (they rise together), and 0 means no link. Adjusting for national income means comparing countries with the same GDP per person, so differences in wealth can’t explain the link. Income is used in percentage terms, since an extra $1,000 means more to a poor country than to a rich one. p is how likely a link this strong would be if there were really none. Below 0.05 means it is unlikely to be chance. Very small values are written in short form: 1.1e-32 means a decimal point followed by 31 zeros and then 11, so very close to zero. The likely range is where the true figure probably lies, and a range that crosses zero means the link could easily be chance. Countries in the same region tend to resemble each other, so the third figure allows for that, which gives a fairer p. The standard error is the typical size of the error in r. Finally, testing this many pairs means some will look strong by luck alone. A q below 0.05 means this link is unlikely to be one of those.

DTP3 immunisation · % of children aged 12-23 monthslink with income +0.53 · moderate
Skilled birth attendance · % of birthslink with income +0.69 · high

“Link with income” is how closely each measure tracks GDP per person across countries, from −1 to +1.

Every country as a dot

DTP3 immunisation · % of children aged 12-23 months →Skilled birth attendance · % of births →39%99%31.9%100%Afghanistan: 59% of children aged 12-23 months, 61.8% of birthsAngola: 64% of children aged 12-23 months, 49.6% of birthsAlbania: 97% of children aged 12-23 months, 99.8% of birthsAndorra: 98% of children aged 12-23 months, 100% of birthsUnited Arab Emirates: 96% of children aged 12-23 months, 99.2% of birthsArgentina: 75% of children aged 12-23 months, 98.8% of birthsArmenia: 94% of children aged 12-23 months, 99.8% of birthsAntigua and Barbuda: 99% of children aged 12-23 months, 99% of birthsAustralia: 93% of children aged 12-23 months, 96% of birthsAustria: 85% of children aged 12-23 months, 98.1% of birthsAzerbaijan: 51% of children aged 12-23 months, 99.9% of birthsBurundi: 89% of children aged 12-23 months, 76.5% of birthsBenin: 63% of children aged 12-23 months, 78.1% of birthsBurkina Faso: 91% of children aged 12-23 months, 79.8% of birthsBangladesh: 97% of children aged 12-23 months, 59% of birthsBulgaria: 94% of children aged 12-23 months, 94.5% of birthsBahrain: 96% of children aged 12-23 months, 99.6% of birthsBahamas, The: 90% of children aged 12-23 months, 99% of birthsBosnia and Herzegovina: 79% of children aged 12-23 months, 99.9% of birthsBelarus: 98% of children aged 12-23 months, 99.9% of birthsBelize: 88% of children aged 12-23 months, 94.6% of birthsBolivia: 59% of children aged 12-23 months, 81.1% of birthsBrazil: 91% of children aged 12-23 months, 98.4% of birthsBarbados: 94% of children aged 12-23 months, 98.4% of birthsBrunei Darussalam: 99% of children aged 12-23 months, 99.6% of birthsBhutan: 98% of children aged 12-23 months, 98.9% of birthsBotswana: 95% of children aged 12-23 months, 99.8% of birthsCentral African Republic: 42% of children aged 12-23 months, 40.3% of birthsCanada: 92% of children aged 12-23 months, 98% of birthsChile: 95% of children aged 12-23 months, 99.8% of birthsChina: 97% of children aged 12-23 months, 99.9% of birthsCote d'Ivoire: 77% of children aged 12-23 months, 84% of birthsCameroon: 77% of children aged 12-23 months, 69% of birthsCongo, Dem. Rep.: 65% of children aged 12-23 months, 85.2% of birthsCongo, Rep.: 78% of children aged 12-23 months, 91.2% of birthsColombia: 89% of children aged 12-23 months, 98.8% of birthsComoros: 75% of children aged 12-23 months, 82.2% of birthsCabo Verde: 93% of children aged 12-23 months, 97.3% of birthsCosta Rica: 99% of children aged 12-23 months, 99% of birthsCyprus: 94% of children aged 12-23 months, 99.3% of birthsCzechia: 86% of children aged 12-23 months, 99.8% of birthsGermany: 89% of children aged 12-23 months, 96.2% of birthsDjibouti: 77% of children aged 12-23 months, 87.4% of birthsDominica: 90% of children aged 12-23 months, 100% of birthsDenmark: 96% of children aged 12-23 months, 95.3% of birthsDominican Republic: 87% of children aged 12-23 months, 99.2% of birthsAlgeria: 92% of children aged 12-23 months, 98.8% of birthsEcuador: 70% of children aged 12-23 months, 99.4% of birthsEgypt, Arab Rep.: 97% of children aged 12-23 months, 97.1% of birthsSpain: 94% of children aged 12-23 months, 99.9% of birthsEstonia: 81% of children aged 12-23 months, 99.6% of birthsEthiopia: 73% of children aged 12-23 months, 49.8% of birthsFinland: 91% of children aged 12-23 months, 99.5% of birthsFiji: 94% of children aged 12-23 months, 99.8% of birthsFrance: 96% of children aged 12-23 months, 98.2% of birthsGabon: 61% of children aged 12-23 months, 89.3% of birthsGeorgia: 86% of children aged 12-23 months, 99.8% of birthsGhana: 95% of children aged 12-23 months, 78.9% of birthsGuinea: 63% of children aged 12-23 months, 55.3% of birthsGambia, The: 80% of children aged 12-23 months, 83.8% of birthsGuinea-Bissau: 68% of children aged 12-23 months, 53.8% of birthsEquatorial Guinea: 68% of children aged 12-23 months, 68.3% of birthsGreece: 95% of children aged 12-23 months, 99.9% of birthsGrenada: 93% of children aged 12-23 months, 100% of birthsGuatemala: 81% of children aged 12-23 months, 69.6% of birthsGuyana: 98% of children aged 12-23 months, 97.6% of birthsHonduras: 75% of children aged 12-23 months, 94.1% of birthsCroatia: 92% of children aged 12-23 months, 99.9% of birthsHaiti: 60% of children aged 12-23 months, 41.6% of birthsHungary: 99% of children aged 12-23 months, 99.7% of birthsIndonesia: 78% of children aged 12-23 months, 94.7% of birthsIndia: 94% of children aged 12-23 months, 89.4% of birthsIreland: 92% of children aged 12-23 months, 99.7% of birthsIran, Islamic Rep.: 98% of children aged 12-23 months, 99% of birthsIraq: 90% of children aged 12-23 months, 95.6% of birthsIceland: 94% of children aged 12-23 months, 97.4% of birthsItaly: 94% of children aged 12-23 months, 99.8% of birthsJamaica: 99% of children aged 12-23 months, 99.7% of birthsJordan: 96% of children aged 12-23 months, 99.7% of birthsJapan: 99% of children aged 12-23 months, 99.8% of birthsKazakhstan: 98% of children aged 12-23 months, 99.9% of birthsKenya: 91% of children aged 12-23 months, 70.2% of birthsKyrgyz Republic: 85% of children aged 12-23 months, 100% of birthsCambodia: 83% of children aged 12-23 months, 98.7% of birthsKiribati: 94% of children aged 12-23 months, 91.9% of birthsSt. Kitts and Nevis: 97% of children aged 12-23 months, 100% of birthsKorea, Rep.: 97% of children aged 12-23 months, 100% of birthsKuwait: 99% of children aged 12-23 months, 99.9% of birthsLao PDR: 67% of children aged 12-23 months, 64.4% of birthsLiberia: 83% of children aged 12-23 months, 84.4% of birthsLibya: 86% of children aged 12-23 months, 99.9% of birthsSt. Lucia: 99% of children aged 12-23 months, 100% of birthsSri Lanka: 97% of children aged 12-23 months, 99.5% of birthsLesotho: 86% of children aged 12-23 months, 86.6% of birthsLithuania: 89% of children aged 12-23 months, 100% of birthsLatvia: 97% of children aged 12-23 months, 99.9% of birthsMorocco: 96% of children aged 12-23 months, 86.6% of birthsMoldova: 86% of children aged 12-23 months, 99.6% of birthsMadagascar: 60% of children aged 12-23 months, 45.8% of birthsMaldives: 99% of children aged 12-23 months, 99.5% of birthsMexico: 78% of children aged 12-23 months, 96.6% of birthsMarshall Islands: 85% of children aged 12-23 months, 92.4% of birthsNorth Macedonia: 89% of children aged 12-23 months, 100% of birthsMali: 82% of children aged 12-23 months, 67.3% of birthsMalta: 97% of children aged 12-23 months, 99.8% of birthsMyanmar: 71% of children aged 12-23 months, 60.2% of birthsMontenegro: 81% of children aged 12-23 months, 98.8% of birthsMongolia: 96% of children aged 12-23 months, 99.3% of birthsMozambique: 70% of children aged 12-23 months, 73% of birthsMauritania: 86% of children aged 12-23 months, 70.4% of birthsMauritius: 93% of children aged 12-23 months, 99.7% of birthsMalawi: 91% of children aged 12-23 months, 96.4% of birthsMalaysia: 93% of children aged 12-23 months, 99.6% of birthsNamibia: 74% of children aged 12-23 months, 88.2% of birthsNiger: 86% of children aged 12-23 months, 43.7% of birthsNigeria: 67% of children aged 12-23 months, 50.7% of birthsNicaragua: 89% of children aged 12-23 months, 94.1% of birthsNorway: 97% of children aged 12-23 months, 99.2% of birthsNepal: 97% of children aged 12-23 months, 77.2% of birthsNew Zealand: 89% of children aged 12-23 months, 96.5% of birthsOman: 99% of children aged 12-23 months, 99.9% of birthsPakistan: 87% of children aged 12-23 months, 68% of birthsPanama: 72% of children aged 12-23 months, 95% of birthsPeru: 80% of children aged 12-23 months, 94.9% of birthsPhilippines: 71% of children aged 12-23 months, 84.4% of birthsPalau: 97% of children aged 12-23 months, 97.2% of birthsPapua New Guinea: 42% of children aged 12-23 months, 56.4% of birthsPoland: 94% of children aged 12-23 months, 99.6% of birthsPortugal: 99% of children aged 12-23 months, 98.6% of birthsParaguay: 80% of children aged 12-23 months, 92.2% of birthsWest Bank and Gaza: 88% of children aged 12-23 months, 99.7% of birthsQatar: 96% of children aged 12-23 months, 100% of birthsRomania: 79% of children aged 12-23 months, 93% of birthsRussian Federation: 97% of children aged 12-23 months, 99.6% of birthsRwanda: 98% of children aged 12-23 months, 94.2% of birthsSaudi Arabia: 97% of children aged 12-23 months, 94.8% of birthsSudan: 39% of children aged 12-23 months, 77.7% of birthsSenegal: 91% of children aged 12-23 months, 74.5% of birthsSingapore: 97% of children aged 12-23 months, 99.6% of birthsSolomon Islands: 87% of children aged 12-23 months, 86.2% of birthsSierra Leone: 91% of children aged 12-23 months, 86.9% of birthsEl Salvador: 95% of children aged 12-23 months, 99.9% of birthsSomalia, Fed. Rep.: 70% of children aged 12-23 months, 31.9% of birthsSerbia: 95% of children aged 12-23 months, 99.9% of birthsSao Tome and Principe: 87% of children aged 12-23 months, 96.8% of birthsSuriname: 69% of children aged 12-23 months, 98.4% of birthsSlovak Republic: 96% of children aged 12-23 months, 98% of birthsSlovenia: 90% of children aged 12-23 months, 99.8% of birthsEswatini: 84% of children aged 12-23 months, 88.3% of birthsSeychelles: 94% of children aged 12-23 months, 99.5% of birthsChad: 68% of children aged 12-23 months, 47.2% of birthsTogo: 90% of children aged 12-23 months, 69.4% of birthsThailand: 92% of children aged 12-23 months, 99.1% of birthsTajikistan: 97% of children aged 12-23 months, 94.8% of birthsTurkmenistan: 98% of children aged 12-23 months, 100% of birthsTimor-Leste: 83% of children aged 12-23 months, 56.7% of birthsTonga: 99% of children aged 12-23 months, 98.3% of birthsTrinidad and Tobago: 92% of children aged 12-23 months, 100% of birthsTunisia: 97% of children aged 12-23 months, 99.5% of birthsTurkiye: 99% of children aged 12-23 months, 97% of birthsTuvalu: 94% of children aged 12-23 months, 99.5% of birthsTanzania: 83% of children aged 12-23 months, 63.5% of birthsUganda: 91% of children aged 12-23 months, 74.2% of birthsUkraine: 88% of children aged 12-23 months, 99.9% of birthsUruguay: 94% of children aged 12-23 months, 100% of birthsUnited States: 94% of children aged 12-23 months, 99.1% of birthsUzbekistan: 90% of children aged 12-23 months, 99% of birthsSt. Vincent and the Grenadines: 99% of children aged 12-23 months, 98.6% of birthsViet Nam: 97% of children aged 12-23 months, 96.1% of birthsVanuatu: 71% of children aged 12-23 months, 89.4% of birthsSamoa: 85% of children aged 12-23 months, 88.9% of birthsSouth Africa: 74% of children aged 12-23 months, 96.7% of birthsZambia: 91% of children aged 12-23 months, 80.4% of birthsZimbabwe: 91% of children aged 12-23 months, 86% of birthsAZEBGDCAFGABHTIKWTLCANEROMNPNGSDNSOM

best-fit line line after adjusting

Four ways to measure the link

MethodrpCountries
Standard (Pearson), not adjusted+0.6151.9e-19174
By rank (Spearman), not adjusted+0.5609.6e-16174
Standard (Pearson), adjusted for national income+0.4227.0e-9174
By rank (Spearman), adjusted for national income+0.3271.1e-5174

The rank version uses only each country’s place in line, from lowest to highest, so a few extreme countries count for less. The adjusted and unadjusted versions use the same 174 countries: those that report both measures and GDP per person. So the gap between them comes from the adjustment, not from a change in which countries are counted. Drop in the size of r after adjusting: +0.192 (a minus sign means it grew).

How solid is it?

Leaving out one country at a time, r ranges from +0.400 (without CAF) to +0.452 (without SDN). The bar above shows that range on a scale from −1 to +1, with the solid line at the full result. The single country that moves r most: SDN (+0.029).

Fragile: this link may not hold up.
  • correlation moves sharply once outliers are trimmed

Within each region

Countries are not separate, unrelated cases, and neighbors share a lot. A link that holds inside each region is far more believable than one that shows up only when comparing regions.

nr
East Asia & Pacific27+0.71
Europe & Central Asia43-0.02
Latin America & Caribbean31+0.39
Middle East, North Africa, Afghanistan & Pakistan19+0.57
Sub-Saharan Africa46+0.45

By income third

If the link shows up only in the richest third of countries, it is a feature of rich countries, not a general pattern.

nr
Poorest third58+0.44
Middle third58+0.51
Richest third58+0.36

By largest religious group

Countries grouped by a label they share, such as main religion, rather than by a number. Groups of fewer than twelve countries are not shown. These groups differ in income, region and history all at once. So a gap between them is a place to start asking questions, not an answer.

nr
Christians102+0.52
Muslims47+0.19

By last european coloniser

Countries grouped by a label they share, such as main religion, rather than by a number. Groups of fewer than twelve countries are not shown. These groups differ in income, region and history all at once. So a gap between them is a place to start asking questions, not an answer.

nr
France23+0.46
Never a European colony21+0.24
Spain19+0.41
United Kingdom61+0.46

Without outliers (countries far outside the middle half of countries on either measure, by more than one and a half times the width of that middle half): r = +0.270 after dropping 20 countries.

Two series, one country

Both measures over the years for one country you pick. The two charts are stacked so they share only the years along the bottom.

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Over time, within countries

Everything above compares countries with each other at one moment. This section compares each country only with itself over 33years. So a link here can’t come from anything about a country that stays the same, such as its history, geography, institutions or culture.

The link shows up within countries over time (r = +0.301) but mostly disappears in year-to-year changes (r = +0.008). That points to slow trends particular to each country, not the two measures moving together from year to year.

Across countries (adjusted)+0.422for comparison
Within countries+0.375each country vs itself
…and vs the same year elsewhere+0.301q = 0.000 · 166 countries
Year-on-year changes+0.008q = 0.858
Read with care.
  • The association is much weaker in year-on-year changes than in levels, which points to shared country-specific trends.

2,768 country-years (one country in one year), 166 countries, 1990–2022, about 17 years each on average. Share of the variation that happens within countries over time: 13% for DTP3 immunisation, 32% for Skilled birth attendance. The margins of error allow for each country appearing many times, and for each year’s value being close to the year before.

Year-to-year changes are a cautious test, not a final answer. Looking only at changes from one year to the next removes each country’s own trends. But it also makes measurement mistakes louder, which pulls the results toward zero. A near-zero result here is weak evidence of no link, not proof.

With one measure years behind the other

0.40−0.4-100+10years Skilled birth attendance trails DTP3 immunisation →lag -10: r = 0.042 (n = 2,230)lag -9: r = 0.079 (n = 2,344)lag -8: r = 0.112 (n = 2,455)lag -7: r = 0.116 (n = 2,548)lag -6: r = 0.134 (n = 2,648)lag -5: r = 0.171 (n = 2,736)lag -4: r = 0.184 (n = 2,783)lag -3: r = 0.208 (n = 2,807)lag -2: r = 0.234 (n = 2,806)lag -1: r = 0.271 (n = 2,788)lag +0: r = 0.301 (n = 2,768)lag +1: r = 0.322 (n = 2,707)lag +2: r = 0.333 (n = 2,653)lag +3: r = 0.327 (n = 2,600)lag +4: r = 0.339 (n = 2,537)lag +5: r = 0.350 (n = 2,478)lag +6: r = 0.369 (n = 2,399)lag +7: r = 0.326 (n = 2,335)lag +8: r = 0.310 (n = 2,243)lag +9: r = 0.258 (n = 2,155)lag +10: r = 0.231 (n = 2,061)

Same year (lag 0): +0.301. A peak away from zero does not show which comes first. These series change slowly — this year’s value is close to last year’s. That makes the curve smooth and nearly symmetric, whatever produced the data. Even a sharp peak at one lag (a gap of some years) would not prove that one measure changes the other.

The largest value on this curve (+0.37 at lag +6) is higher than the same-year one by 0.07. That gap is not a finding. It is the largest of 21 closely related estimates, and picking the biggest of many tests always makes it look bigger. That is exactly why nothing on this site is ranked or chosen by lag.

The data


% of children aged 12-23 months
% of births		Years
St. Vincent and the Grenadines VCT99%98.6%2024, 2016
Turkiye TUR99%97%2024, 2019
Tonga TON99%98.3%2024, 2019
Portugal PRT99%98.6%2024, 2020
Oman OMN99%99.9%2024, 2020
Maldives MDV99%99.5%2024, 2017
St. Lucia LCA99%100%2024, 2019
Kuwait KWT99%99.9%2024, 2019
Japan JPN99%99.8%2024, 2021
Jamaica JAM99%99.7%2024, 2018
Hungary HUN99%99.7%2024, 2017
Costa Rica CRI99%99%2024, 2019
Brunei Darussalam BRN99%99.6%2024, 2021
Antigua and Barbuda ATG99%99%2024, 2020
Turkmenistan TKM98%100%2024, 2019

World Bank, World Development Indicators
World Bank, World Development Indicators

Sources

DTP3 immunisation

Immunization, DPT (% of children ages 12-23 months)

WHO and UNICEF · CC BY 4.0 · updated quarterly

Three doses of the diphtheria, tetanus and whooping cough (pertussis) vaccine, the standard measure of a routine vaccination system. Measles coverage is published the same way and moves with it almost exactly, so only one of the two is here.

Skilled birth attendance

Births attended by skilled health staff (% of total)

UNICEF and WHO · CC BY 4.0 · updated quarterly

Based on surveys, so a country reports it every few years rather than yearly.

How this was computed

Data used: most recent value in 2010-2025; values come from 2011–2024. To adjust for income, each measure is first predicted from GDP per person (in percentage terms, on a log scale) with a straight-line fit. Only what is left over is then compared. This is called a partial correlation. The line is drawn the standard way (ordinary least squares), which picks the line that comes closest to all the countries at once. The error margins allow for countries in the same region resembling each other, using 7 World Bank regions. The q-value corrects for testing all 12,497 pairs at once, using the Benjamini–Hochberg method. Underlying data last updated DYB 2024. How the country data works · explore DTP3 immunisation and Skilled birth attendance

This page shows that two measures go together. It does not show that DTP3 immunisation changes Skilled birth attendance, or the reverse. These figures also describe countries, not individual people. See the ecological fallacy.

More links with DTP3 immunisation or Skilled birth attendance