Ensuring that all births are assisted by skilled birth attendants is a critical strategy for reducing maternal and newborn morbidity and mortality. Reflecting its importance in reducing maternal morbidity and mortality, skilled birth attendance was included as indicator 3.1.2 under goal 3 and target 3.1 of the Sustainable Development Goals.
Globally in 2019, 81 per cent of births were assisted by skilled health professionals, which generally includes a medical doctor, nurse or midwife. However, population growth poses an impending challenge for the coverage of essential maternal and newborn health care services. While most regions are projected to experience a decline in the number of annual births between 2019 and 2030, Africa will see a 14 per cent increase. Based on this projection in the number of births and assuming current coverage levels of skilled birth attendants will stay the same, an estimated 19 million births in Africa will not be attended by a skilled provider in 2030. This future prospect means that substantially more resources will be required to increase intervention coverage levels and to stay apace with population changes happening in the continent.
While coverage of skilled birth attendant is 60 per cent in sub-Saharan Africa and 77 per cent in Southern Asia, other regions like Central Asia, Eastern Asia, Western Asia, Northern America and Europe, have achieved universal coverage.
Despite these challenges, Southern Asia and sub-Saharan Africa were regions with the greatest progress in increasing coverage of births assisted by health professionals by 2019.
To improve maternal and newborn survival across all ages, skilled health personnel should be capable of handling normal deliveries safely. They must also be able to recognize warning signs for complications and refer mothers to emergency care. Non-skilled attendants, including traditional birth attendants, can neither predict nor appropriately manage serious complications such as haemorrhage or sepsis, which are the leading killers of mothers during and after childbirth.
Despite substantial progress over the last two decades, inadequate or non-existent care during pregnancy and delivery was largely responsible for the annual death of an estimated 295,000 mothers in 2017 and 2.5 million newborns in the first month of life in 2018. Indeed, roughly three-quarters of all maternal deaths take place during delivery and in the immediate postpartum period.
Adolescent mothers
Currently, the highest rates of early childbearing are found in sub-Saharan African countries, where in 2018 birth rates among adolescents reached over 100 births per 1,000 girls aged 15-19, compared to lower rates in other regions. It is important that girls in this vulnerable group receive the necessary care during antenatal period and delivery to ensure their wellbeing and that of their babies as well as education on family planning. See more
Disparities in coverage
Despite the progress made, large equity gaps remain, with the rural or the poorest population often left behind. Globally in 2018, approximately 67 per cent of births among rural mothers are attended by skilled health personnel, compared to about 89 per cent of births among urban mothers. The urban-rural gap remains at over 20 per cent despite progress in the past 15 years.
Large disparities in delivery care are also observed across wealth quintiles. Globally, women in the richest 20 per cent of their countries’ population were almost 2 times more likely than women in the poorest quintile to have a skilled birth attendant at delivery (91 per cent versus 51 per cent). Differences across wealth quintiles are largest in sub-Saharan Africa with the richest being 2.4 times more likely to deliver with the help of a skilled health provider than the poorest (37 per cent versus 88 per cent). This is especially true in West and Central Africa where the richest 20 per cent of mothers were almost 3 times as likely to have a skilled birth attendance at delivery than mothers in the poorest 20 per cent of the households (32 per cent versus 88 per cent).
Delivery in health facilities
Monitoring deliveries in health facilities is essential to ensuring that women receive quality care and deliver in an environment that is prepared for an emergency. In many countries, particularly middle- and high-income countries, a large proportion of babies are delivered in health facilities. Delivery in a health facility increases access to appropriate equipment and supplies available on site or through immediate referral to a higher level facility. However it remains essential to also ensure that the delivery is carried out by skilled health personnel, capable of anticipating or detecting signs and symptoms of complications. In Eastern Europe and Central Asia (98 per cent), Western Europe (99 per cent), Latin America and the Caribbean (94 per cent) as well as East Asia and the Pacific (91 per cent), over 9 in 10 births occurred in health facilities. In contrast, in sub-Saharan Africa where the burden of maternal and newborn deaths is highest, just over half of all births (57 per cent) were delivered in a health facility and the urban-rural gap was 30 per cent (78 per cent vs. 48 per cent) and the gap between women from the richest and poorest quintiles of their national populations was a staggering 49 per cent (85 per cent vs. 36 per cent).
The percentage of births taking place in a health facility varies by UNICEF region
References
UNICEF, The State of the World’s Children 2019, UNICEF, New York, 2019.
UNICEF, Healthy Mothers, Healthy Newborns: Taking Stock of Maternal Health. UNICEF, New York, 2019
UNICEF, Committing to Child Survival: A Promise Renewed – 2015, UNICEF, New York, 2015.
WHO, UNFPA, UNICEF, AMDD, Monitoring Emergency Obstetric Care – A handbook, 2009 revision, WHO, Geneva 2009.
WHO, UNICEF, UNFPA and The World Bank, Trends in Maternal Mortality: 2000 to 2017, WHO, Geneva, 2019.
