In general, discussions about care during labor and delivery tend to focus on two groups: women who deliverwith assistance from a skilled birth attendant, such as a midwife or doctor, and those who do not, as giving birth with assistance from a skilled provider is often considered the single most important intervention for ensuring that women deliver safely. In most settings, women in the second group give birth with assistance from someone, usually a traditional birth attendant. However, in some places, including Nigeria, where one in seven of the world’s maternal deaths occur, this group also includes women who give birth entirely alone. In “When women deliver with no one present in Nigeria: who, what, where and so what?“an article published earlier this month in PLOS ONE, Bolaji M. Fapohunda and Nosakhare G. Orobaton, explore the factors that contribute to making the practice of giving birth with no one present (NOP) so common. Using data from the 2008 Demographic and Health Survey, the authors assessed a wide variety of factors that might contribute to the high proportion of NOP births and, in turn, may offer clues for efforts to change this situation. The authors found that the practice is heavily concentrated in the northern part of Nigeria, and associated with a set of sociodemographic, economic and social issues. From the article:
Mother’s education, higher wealth quintiles, urban residence, decision-making autonomy, and a supportive environment for women’s social and economic security were inversely associated with NOP deliveries. Women’s autonomy and social standing were critical to choosing to deliver with skilled attendance, which were further amplified by economic prosperity. . . Programs that seek to improve the autonomy of women and their strategic participation in sound health seeking decisions will, most likely, yield better results with improvements in women’s education, income, jobs, and property ownership. As a short term measure, the use of conditional cash transfer, proven to work in several countries, including 18 in sub-Saharan Africa, is recommended.
They also note that these sort of demand-side approaches are not the only – and may not even be the most important – factors, given that there are severe shortcomings in access and quality of maternal health services.