Recent efforts to reduce maternal mortality in developing countries have focused primarily on two long-term aims: training and deploying skilled birth attendants and upgrading emergency obstetric care facilities. Given the future population-level benefits, strengthening of health systems makes excellent strategic sense but it does not address the immediate safe-delivery needs of the estimated 45 million women who are likely to deliver at home, without a skilled birth attendant. There are currently 28 countries from four major regions in which fewer than half of all births are attended by skilled birth attendants. Sixty-nine percent of maternal deaths in these four regions can be attributed to these 28 countries, despite the fact that these countries only constitute 34% of the total population in these regions. Trends documenting the change in the proportion of births accompanied by a skilled attendant in these 28 countries over the last 15-20 years offer no indication that adequate change is imminent. To rapidly reduce maternal mortality in regions where births in the home without skilled birth attendants are common, governments and community-based organizations could implement a cost-effective, complementary strategy involving health workers who are likely to be present when births in the home take place. Training community-based birth attendants in primary and secondary prevention technologies (e.g. misoprostol, family planning, measurement of blood loss, and postpartum care) will increase the chance that women in the lowest economic quintiles will also benefit from global safe motherhood efforts.
This study assessed antenatal care (ANC) coverage, place of delivery and use of skilled birth assistants in three communities in Kaduna State, Nigeria. The sample included 332 women who had delivered within two years of the survey. ANC attendance rates were high, with 76.2% of women reporting at least one visit, and 63.3% receiving four or more. However, median gestational age at the first visit was four months and only 9.3% received all the recommended components. Health facility deliveries (11.7%) were far lower than ANC attendance. Educational status was found to be statistically significantly associated with all ANC and safe delivery outcomes. To make significant progress towards the fifth MDG in northern Nigeria, effective strategies to encourage women’s education paired with improvements in ANC quality (especially within communities) is essential. Most importantly, safer delivery options that would be acceptable in communities where women traditionally birth at home need to be explored (Afr. J. Reprod. Health 2010; 14: 89-96).