We have had much discussion on HIFA about how to improve the safety of childbirth in Nigeria and other low- and middle-income countries; the importance of access to a skilled birth attendant; and the role of (trained) traditional birth attendants where skilled attendance is not available. This new paper is a reminder that huge numbers of women give birth alone, with no one present, not even a TBA. Such women ‘neither have access to skilled attendance nor do they have the marginal protection and social support supplied by an unskilled birth companion’. Previous research has found that ‘almost 20% of all women in Nigeria had given birth with NOP in 2008, and the most recent data available show… the proportion of women giving birth with NOP is still unacceptably high, 14% nationally in 2013’. The paper identifies some socio-economic factors associated with birth alone. These factors include the denial of women’s rights to make decisions surrounding their health care.
CITATION: Austin A, Fapohunda B, Langer A, Orobaton N. Trends in delivery with no one present in Nigeria between 2003 and 2013. International Journal of Women’s Health. 2015:7:345—356 DOI http://dx.doi.org/10.2147/IJWH.S79573
ABSTRACT
Purpose: Skilled attendance at birth is a proven intervention to improve maternal and newborn health outcomes. Unfortunately, in Nigeria there are many women who give birth alone, with no one present (NOP). The purpose of this study was to document trends in women delivering with NOP between 2003 and 2013, and to identify the characteristics of women who are engaging in this risky practice.
Methods: We utilized pooled data sets from the 2003, 2008, and 2013 Nigerian Demographic and Health Surveys. Married women, who had given birth in the 5 years before each survey were included, resulting in a sample size of 38,949 women. We used logistic regression to assess the unadjusted and adjusted odds of a woman delivering with NOP over time, by sociodemographic characteristics.
Results: Prevalence of delivery with NOP in Nigeria declined by 30% between 2003 and 2013. The largest declines occurred in Sokoto State, where the number of women giving birth with NOP declined by almost 100% between 2003 and 2013. In the North West of the country, however, there was a 27% increase in the number of women giving birth alone over this time period. Older, poorer, less educated, higher parity, Muslim women residing in the Northern regions were significantly more likely to give birth with NOP. Women, who were involved in decisions surrounding their own health, and who had accessed antenatal care were significantly less likely to give birth with NOP.
Conclusion: Although there have been improvements in Nigeria’s Maternal Mortality Ratio since 1990, recent estimates suggest a stagnation in this trend. One reason for this protracted decline may be lack of access to skilled delivery care. The 2013 national prevalence of Nigerian women giving birth with NOP was 14%, equivalent to over 1 million births in 2013. Nigeria must implement interventions to ensure every woman’s timely access to, and use of skilled care to reduce preventable maternal mortality and morbidity.
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Best wishes, Neil
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