Do Pupil-teacher ratio and Skilled birth attendance go together across countries?

Across 163 countries the link before adjusting for anything is r = -0.72, on a scale from -1 (opposite) to +1 (in step). A version that uses only each country's rank gives -0.72.

Does the link hold within countries over time, not just across countries?

Comparing each country only with itself across 1990-2019, and setting aside what happened worldwide in each year, the link is -0.094 (134 countries, 1,771 country-years). Using year-to-year changes, it is -0.035.

Does Pupil-teacher ratio cause Skilled birth attendance?

This analysis cannot answer that. It shows only that the two go together. A link between two country measures, adjusted or not, does not show that either one changes the other. Country figures also say nothing about individual people.

Pupil-teacher ratio vs. Skilled birth attendance

Holds up after adjusting for income

Across 163 countries, Pupil-teacher ratio and Skilled birth attendance rise and fall together at r = -0.72 (on a scale from −1 to +1, where 0 means no link). Comparing only countries with similar income (GDP per person) shrinks it to -0.41 (q = 0.027, allowing for the many pairs tested). Much of the first figure is that both measures rise with national income, but a moderate negative link remains.

Comparing countries across the middle half of skilled birth attendance, 86.1% to 99.7% of births, pupil-teacher ratio is better by 8.42 pupils per teacher at the top of that range than the bottom. Comparing only countries with similar national income, the gap is 3.97 pupils per teacher.

Link before adjusting (r)-0.721p = 2.0e-27 · 163 countries

After adjusting for national income-0.413p = 4.7e-8 · likely range [-0.53, -0.28]

p, allowing for regions0.001standard error 0.062 · 7 regions

Check for luck (q)0.027across 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.

Pupil-teacher ratio · pupils per teacherlink with income -0.83 · proxy

Skilled birth attendance · % of birthslink with income +0.69 · high

Both of these rise and fall closely with national income, so a strong link between them before adjusting was close to certain. Read the adjusted figure, not the first one.

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

Every country as a dot

best-fit line line after adjusting

Four ways to measure the link

Method	r	p	Countries
Standard (Pearson), not adjusted	-0.721	2.0e-27	163
By rank (Spearman), not adjusted	-0.719	2.8e-27	163
Standard (Pearson), adjusted for national income	-0.413	4.7e-8	163
By rank (Spearman), adjusted for national income	-0.350	4.8e-6	163

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 163 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: +0.308 (a minus sign means it grew).

How solid is it?

Leaving out one country at a time, r ranges from -0.457 (without RWA) to -0.373 (without CAF). 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: RWA (-0.044).

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.

	n	r
East Asia & Pacific	24	-0.08
Europe & Central Asia	41	-0.17
Latin America & Caribbean	29	-0.03
Middle East, North Africa, Afghanistan & Pakistan	17	-0.74
Sub-Saharan Africa	44	-0.41

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.

	n	r
Poorest third	55	-0.43
Middle third	54	+0.07
Richest third	54	-0.23

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.

	n	r
Christians	96	-0.41
Muslims	42	-0.66

By last european coloniser

	n	r
France	22	-0.07
Never a European colony	20	-0.67
Spain	18	+0.16
United Kingdom	54	-0.35

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 = -0.377 after dropping 19 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 30years. So a link here can’t come from anything about a country that stays the same, such as its history, geography, institutions or culture.

Within countries over time, there is no link that is clearly more than chance (r = -0.094, comparing each country only with itself over the years, and each year only with the same year elsewhere). Whatever the cross-country picture shows, countries whose pupil-teacher ratio moved did not tend to see their skilled birth attendance move with it.

Across countries (adjusted)-0.413for comparison

Within countries-0.318each country vs itself

…and vs the same year elsewhere-0.094q = 0.278 · 134 countries

Year-on-year changes-0.035q = 0.639

Read with care.

Almost all of the second indicator's variation is between countries, so the within-country estimate rests on a small part of the data.
Much of the within-country association disappears once shared global year effects are removed, which points to a common worldwide trend rather than a country-level relationship.

1,771 country-years (one country in one year), 134 countries, 1990–2019, about 13 years each on average. Share of the variation that happens within countries over time: 12% for Pupil-teacher ratio, 10% 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

Same year (lag 0): -0.094. 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 data

	pupils per teacher	% of births	Years
Central African Republic CAF	83.4	40.3%	2016, 2019
Rwanda RWA	59.5	94.2%	2018, 2020
Malawi MWI	58.7	96.4%	2018, 2020
Chad TCD	56.9	47.2%	2016, 2019
Mozambique MOZ	55.3	73%	2018, 2015
Ethiopia ETH	55.1	49.8%	2011, 2019
Guinea-Bissau GNB	51.9	53.8%	2010, 2019
Tanzania TZA	50.6	63.5%	2018, 2016
Angola AGO	50	49.6%	2015, 2016
Afghanistan AFG	48.8	61.8%	2018, 2020
Guinea GIN	47.1	55.3%	2016, 2018
Cameroon CMR	44.8	69%	2018
Congo, Rep. COG	44.4	91.2%	2012, 2015
Pakistan PAK	44.1	68%	2018, 2020
Uganda UGA	42.7	74.2%	2017, 2016

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

Sources

Pupil-teacher ratio

Pupil-teacher ratio, primary

UNESCO Institute for Statistics · CC BY 4.0 · updated quarterly

The World Bank's copy stops at 2019.

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 2010–2022. 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 Pupil-teacher ratio and Skilled birth attendance

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