Abstract
BackgroundHaving a health worker with midwifery skills present at delivery is one of the key interventions to reduce maternal and newborn mortality. We sought to estimate the frequencies of (a) skilled birth attendant coverage, (b) institutional delivery, and (c) the combination of place of delivery and type of attendant, in LMICs.MethodsNational surveys (DHS and MICS) performed in 80 LMICs since 2005 were analyzed to estimate these four categories of delivery care. Results were stratified by wealth quintile based on asset indices, and by urban/rural residence. The combination of place of delivery and type of attendant were also calculated for seven world regions.ResultsThe proportion of institutional SBA deliveries was above 90 % in 25 of the 80 countries, and below 40 % in 11 countries. A strong positive correlation between SBA and institutional delivery coverage (rho: 0.97, p <0,001) was observed. Eight countries had over 10 % of home SBA deliveries, and two countries had over 10 % of institutional non-SBA deliveries. Except for South Asia, all regions had over 80 % of urban deliveries in the institutional SBA category, but in rural areas, only two regions (CEE & CIS, Middle East & North Africa) presented average coverage above 80 %. In all regions, institutional SBA deliveries were over 80 % in the richest quintile. Home SBA deliveries were more common in rural than in urban areas, and in the poorest quintiles in all regions. Facility non-SBA deliveries also tended to be more common in rural areas and among the poorest.ConclusionFour different categories of delivery assistance were identified worldwide. Pro-urban and pro-rich inequalities were observed for coverage of institutional SBA deliveries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0192-2) contains supplementary material, which is available to authorized users.
Highlights
Having a health worker with midwifery skills present at delivery is one of the key interventions to reduce maternal and newborn mortality
Place of delivery and type of attendant were combined into four categories of delivery assistance, to allow for the possibilities that deliveries in health facilities are not necessarily performed by skilled birth attendant (SBA), and that deliveries outside a health facility do not necessarily represent unskilled birth attendance
We report a high correlation between coverage with SBA and institutional delivery coverage
Summary
Having a health worker with midwifery skills present at delivery is one of the key interventions to reduce maternal and newborn mortality. 2.8 million newborns died annually within 28 days of birth, with 2 million occurring within the first week of life [2, 3], and there are 2.6 million stillbirths of which 45 % occur during childbirth or labor [4]. Most of these deaths (99 %) and Joseph et al Reproductive Health (2016) 13:77. The MDGs have been criticized due to lack of emphasis on inequalities and recent efforts are underway to measure progress towards universal health care from an equity perspective [11, 12]
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