Utilisation of Skilled Birth Attendance in Northern Nigeria

Nigeria has one of the highest levels of maternal mortality in the world, accounting for 10% of maternal deaths worldwide.The use of a skilled birth attendant can be a vital intervention for improving maternal, as well as newborn survival. However, according to the 2008 Demographic Health Survey:

• coverage of use of skilled birth attendants in Nigeria varies across the continuum of care
• 58% of pregnant women received antenatal care at least once
• only 39% received skilled care during childbirth
• 38% received postnatal care from a skilled birth attendant within two days after giving birth

Skilled birth attendance is also lower in the northern states compared to the southern states. This study, published in the journal Midwifery, examines the determinants, barriers and enablers for the use of skilled birth attendants along the continuum of care in Northern Nigeria.

The study is based on a population-based survey conducted in Katsina state from May to June 2012. The survey asked 400 women aged between 15 and 49 years who had a live birth within the two years prior to the study about presence of a skilled birth attendant during antenatal care, childbirth, and postnatal care of their most recent birth.

Key findings include:

• Of the 400 women surveyed:
  • 36.3% (145) received antenatal care
  • only 13% (52) were assisted by skilled birth attendant during the delivery
  • 22% (88) received postnatal care from a skilled birth attendant
• Only 56% of those women who had their births attended by a skilled birth attendant delivered in a health facility
• Predictors for use of skilled birth attendants included
  • maternal education
  • the occupation of the women’s husband
  • the presence of complications
  • previous place of birth
• Barriers to use of skilled birth attendants included no health care provider, no equipment and supplies, and poverty
• Women were more likely to use skilled birth attendants if there was staff available, they had their husband’s approval, and the service was affordable    

The authors conclude that women are likely to use skilled birth attendants if there are skilled personnel available, efforts have been made to strengthen the health system, and mechanisms are in place to remove fees for maternal health services.

It is recommended that efforts should be made collectively by government and community leaders to advocate for girl’s education and encourage men to be more involved in maternal health services.

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