When Women Deliver with No One Present in Nigeria: Who, What, Where and So What?

Abstract

With the current maternal mortality ratio (MMR) of 630/100,000 live births, Nigeria ranks among the nations with the highest mortality rates in the world. The use of skilled assistants during delivery has been identified a key predictor in the reduction of mortality rates in the world over. Not only are Nigerian women predominantly using unskilled attendants, one in five births are delivered with No One Present (NOP). We assessed who, what, where and the so what of this practice using 2008 Nigeria DHS (NDHS) data. The study revealed that the prevalence of NOP is highest in the northern part of Nigeria with 94% of all observed cases. Socio-demographic factors, including, women’s age at birth, birth order, being Muslim, and region of residence, were positively associated with NOP deliveries. 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. Women’s’ economic wellbeing is entwined with their feelings of independence and freedom. 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. Its use has the potential to reduce household budget constraint by lowering cost-related barriers associated with women’s ability to demand and use life-saving services. Given the preponderance of NOP in the Northern region, the study suggests that interventions to eradicate NOP deliveries must initially focus this region as priority.

Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria

“…6,14,15 Certain sociodemographic factors such as sex, educational and socioeconomic status are known to influence the awareness about available health-care services and thus, could either promote or serve as a barrier to the uptake of available health-care services. [16][17][18][19] These factors could differently affect the uptake of such services among people of differing sociodemographic factors in the same setting. Irrespective of these factors, a prepayment scheme as is available under the NHIS could to a large extent ameliorate observed differences in the uptake of health-care services, and therefore be used as a platform for equitable access to available healthcare services regardless of sociodemographic divides.…”

Choice of place of Delivery amongst Women in a Rural Community in northeastern Nigeria

“…poor or no supply of electricity) and equipment (e.g. ambulances); perennial stock out of obstetric care commodities; sub-standard emergency obstetric care (EmOC) and poor compliance with standard of practices; inadequate health worker size, mix, capacity, motivation; weak referral linkages and feedback mechanisms [20] . Other access related factors including high user-fees, limited health facilities within reasonable commuting distance, and poor health workers' attitude in the delivery of healthcare services have been identified by similar studies [18] .…”

Engendering maternal and child health care services in cross river state health agenda in Nigeria: what worked well in a pilot study

“…The Nigerian PHC system, which is one of the three-tier systems, has the main thrust of bringing health care -the main responsibility of the government, to the door steps of Nigerians. These efforts have achieved some gains over the last decade with annual maternal death worldwide now closing towards half of the 1990 estimate [7][8]. Much of these gains are attributable to efforts focused towards specific illnesses responsible for the high rate of maternal mortality globally.…”