Factors influencing the selection of delivery with no one present in northern Nigeria: Implications for policy and programs

International Journal of Women's Health, Volume 6, No. 1, Year 2014

Interpretation

This paper examines the effects of demographic, socioeconomic, and women’s autonomy factors on the utilization of delivery assistance in Sokoto State, Nigeria. Data were obtained from the Nigeria 2008 Demographic and Health Survey (DHS). Bivariate analysis and logistic regression procedures were conducted. The study revealed that delivery with no one present and with unskilled attendance accounted for roughly 95% of all births in Sokoto State. Mothers with existing high risk factors, including higher parity, were more likely to select unsafe/unskilled delivery practices than younger, lower-parity mothers. Evidenced by the high prevalence of delivery with traditional birth attendants, this study demonstrates that expectant mothers are willing to obtain care from a provider, and their odds of using accessible, affordable, skilled delivery is high, should such an option be presented. This conclusion is supported by the high correlation between a mother’s socioeconomic status and the likelihood of using skilled attendance. To improve the access to, and increase the affordability of, skilled health attendants, we recommended two solutions: 1) the use of cash subsidies to augment women’s incomes in order to reduce finance-related barriers in the use of formal health services, thus increasing demand; and 2) a structural improvement that will increase women’s economic security by improving their access to higher education, income, and urban ideation. © 2014 Fapohunda and Orobaton. This study analyzed data obtained from the 2008 Nigeria DHS on maternal and reproductive experiences of women aged 15–49 years.1 The survey was designed to yield a representative sample at the national, zonal/regional, and state levels. This paper is based on the subsample of the data collected from Sokoto State, which comprised 985 women aged 15–49 years and 292 men aged 15–59 years. The study pooled data on a total of 1,089 live births to married Sokoto women between 2003 and 2008, with valid responses on the relevant indicators. Study data were analyzed using the Stata statistical package (StataCorp LP, College Station, TX, USA). Estimates of types of delivery assistance utilized by mothers in 5 years preceding the survey were calculated and disaggregated by demographic (age, birth order); socioeconomic (residence, mother’s education, woman’s employment); and women’s autonomy (participation in decision-making and disapproval of gender norms that foster inequity) factors. Bivariate analyses and multivariate logistic regressions were modeled to identify influential factors that shape the utilization of specific delivery assistant types. Sampling weights were used to control for over- or under-sampling within groups. Details of variables employed in the analysis are presented in Table 1. These variables were developed based on evidence from the literature on maternal health, women’s status, knowledge of the context of the study, and data availability. The variables were categorized into three domains: demographic, socioeconomic, and women’s autonomy. The demographic domain had two variables: age of mother at birth and birth order of children. The socioeconomic domain had four variables: place of residence, education, wealth quintiles, and mother’s employment status. Religion was not included, as over 98% of respondents were Muslim. The women’s autonomy domain also comprised four variables: participation in decision-making in the household, control over personal sexuality, disapproval of wife-beating, and presence of co-wives. The last three variables were also branded as a construct of gender norms that foster inequity. Recent work by Singh et al informed the construction of the women’s autonomy measures.24 Description of outcome and predictor variables Located in the Sahel, Sokoto State occupies a land area of 25,973 square kilometers with a population of 4.6 million people. It is bordered by Niger Republic to the north and Benin Republic in the west; it is bordered to the south and southeast by the Nigerian states of Zamfara and Birnin Kebbi.25 The total fertility rate (TFR) of 8.7 and mortality rate of 1,500/100,000 live births in Sokoto State are among the highest in the country. Utilization rates of maternal and child health services are also very low. For example, the Nigeria DHS found that 1.9% of women of reproductive age reported the current use of any method of contraception; that DPT3 coverage in the region is around 2%; and that 11.6% of children who are under the age of 5 years currently sleep under insecticide-treated bednets.1

AI Digest

Study Justification:

– This study examines the factors that influence the selection of delivery with no one present in Sokoto State, Nigeria.
– It aims to understand the effects of demographic, socioeconomic, and women’s autonomy factors on the utilization of delivery assistance.
– The study is important because delivery with no one present and with unskilled attendance accounted for approximately 95% of all births in Sokoto State.
– It highlights the need to improve access to and affordability of skilled health attendants for safer deliveries.

Study Highlights:

– The study analyzed data from the 2008 Nigeria Demographic and Health Survey.
– It focused on a subsample of 985 women aged 15-49 years and 292 men aged 15-59 years from Sokoto State.
– The study found that mothers with higher parity and existing high-risk factors were more likely to choose unsafe/unskilled delivery practices.
– It also revealed a high correlation between a mother’s socioeconomic status and the likelihood of using skilled attendance.
– The study demonstrated that expectant mothers are willing to obtain care from a provider if accessible and affordable options are available.

Recommendations for Lay Reader and Policy Maker:

– To improve access to skilled health attendants, the study recommends two solutions:
1) Use cash subsidies to augment women’s incomes, reducing finance-related barriers and increasing demand for formal health services.
2) Implement structural improvements to increase women’s economic security, such as improving access to higher education, income, and urban ideation.

Key Role Players Needed to Address Recommendations:

– Government health departments and policymakers
– Non-governmental organizations (NGOs) working in maternal and child health
– Community leaders and traditional birth attendants
– Health professionals and skilled birth attendants
– Educators and trainers for women’s empowerment programs

Cost Items to Include in Planning Recommendations:

– Budget items may include:
– Funding for cash subsidies to augment women’s incomes
– Investments in education and training programs for women’s empowerment
– Infrastructure improvements to enhance access to skilled health attendants
– Support for community outreach and awareness campaigns
– Monitoring and evaluation of program effectiveness
– Capacity building for health professionals and birth attendants
Please note that the cost items mentioned are for planning purposes and not actual costs. The actual budget would depend on the specific context and implementation strategy.

Strength of Evidence

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong, as it is based on data obtained from the Nigeria 2008 Demographic and Health Survey (DHS) and includes bivariate analysis and logistic regression procedures. However, to improve the strength of the evidence, the study could have included a larger sample size and conducted a more recent survey to ensure the findings are still relevant. Additionally, the study could have included a comparison group to further support the conclusions.

Abstract

This study analyzed data obtained from the 2008 Nigeria DHS on maternal and reproductive experiences of women aged 15–49 years.1 The survey was designed to yield a representative sample at the national, zonal/regional, and state levels. This paper is based on the subsample of the data collected from Sokoto State, which comprised 985 women aged 15–49 years and 292 men aged 15–59 years. The study pooled data on a total of 1,089 live births to married Sokoto women between 2003 and 2008, with valid responses on the relevant indicators. Study data were analyzed using the Stata statistical package (StataCorp LP, College Station, TX, USA). Estimates of types of delivery assistance utilized by mothers in 5 years preceding the survey were calculated and disaggregated by demographic (age, birth order); socioeconomic (residence, mother’s education, woman’s employment); and women’s autonomy (participation in decision-making and disapproval of gender norms that foster inequity) factors. Bivariate analyses and multivariate logistic regressions were modeled to identify influential factors that shape the utilization of specific delivery assistant types. Sampling weights were used to control for over- or under-sampling within groups. Details of variables employed in the analysis are presented in Table 1. These variables were developed based on evidence from the literature on maternal health, women’s status, knowledge of the context of the study, and data availability. The variables were categorized into three domains: demographic, socioeconomic, and women’s autonomy. The demographic domain had two variables: age of mother at birth and birth order of children. The socioeconomic domain had four variables: place of residence, education, wealth quintiles, and mother’s employment status. Religion was not included, as over 98% of respondents were Muslim. The women’s autonomy domain also comprised four variables: participation in decision-making in the household, control over personal sexuality, disapproval of wife-beating, and presence of co-wives. The last three variables were also branded as a construct of gender norms that foster inequity. Recent work by Singh et al informed the construction of the women’s autonomy measures.24 Description of outcome and predictor variables Located in the Sahel, Sokoto State occupies a land area of 25,973 square kilometers with a population of 4.6 million people. It is bordered by Niger Republic to the north and Benin Republic in the west; it is bordered to the south and southeast by the Nigerian states of Zamfara and Birnin Kebbi.25 The total fertility rate (TFR) of 8.7 and mortality rate of 1,500/100,000 live births in Sokoto State are among the highest in the country. Utilization rates of maternal and child health services are also very low. For example, the Nigeria DHS found that 1.9% of women of reproductive age reported the current use of any method of contraception; that DPT3 coverage in the region is around 2%; and that 11.6% of children who are under the age of 5 years currently sleep under insecticide-treated bednets.1

Materials

N/A

Innovations

The study recommends two solutions to improve access to maternal health in Sokoto State, Nigeria:

1) Cash subsidies: The study suggests providing cash subsidies to women to increase their income and reduce financial barriers to accessing formal health services. This is expected to increase the demand for skilled health attendants and make their services more accessible and affordable for expectant mothers.

2) Structural improvement: The study recommends improving women’s economic security by increasing their access to higher education, income, and urban ideation. This empowerment of women economically will provide them with more resources and opportunities to seek skilled delivery assistance.

Implementing these recommendations is expected to address the high prevalence of delivery with no one present and with unskilled attendance in Sokoto State. The study highlights the willingness of expectant mothers to seek care from a provider if accessible and affordable options are available. By improving access to skilled health attendants through cash subsidies and structural improvements, it is expected to enhance maternal health outcomes in the region.

AI Innovations Description

The recommendation provided in the study to improve access to maternal health in Sokoto State, Nigeria includes two solutions:

1) Cash subsidies: The study suggests using cash subsidies to augment women’s incomes in order to reduce finance-related barriers in the use of formal health services. By providing financial support, it is expected to increase the demand for skilled health attendants and make their services more accessible and affordable for expectant mothers.

2) Structural improvement: The study also recommends a structural improvement that focuses on increasing women’s economic security. This can be achieved by improving their access to higher education, income, and urban ideation. By empowering women economically, they will have more resources and opportunities to seek skilled delivery assistance.

These recommendations aim to address the high prevalence of delivery with no one present and with unskilled attendance in Sokoto State. The study highlights the willingness of expectant mothers to obtain care from a provider if accessible and affordable options are available. By implementing these recommendations, it is expected to improve access to skilled health attendants and ultimately enhance maternal health outcomes in the region.

AI Innovations Methodology

To simulate the impact of the main recommendations on improving access to maternal health, the following methodology could be used:

1) Data collection: Collect data on the current utilization of delivery assistance in Sokoto State, including the percentage of deliveries with no one present and with unskilled attendance. This data can be obtained through surveys or by analyzing existing data sources such as the Nigeria DHS.

2) Baseline analysis: Conduct a baseline analysis to understand the demographic, socioeconomic, and women’s autonomy factors that influence the utilization of specific delivery assistant types. This analysis can be done using bivariate analysis and logistic regression procedures, similar to the methodology used in the original study.

3) Simulation modeling: Use the baseline analysis results to develop a simulation model that incorporates the impact of the recommended interventions. The model should consider the potential increase in demand for skilled health attendants due to the implementation of cash subsidies and structural improvements.

4) Intervention implementation: Implement the recommended interventions, including providing cash subsidies to augment women’s incomes and improving women’s economic security through access to higher education, income, and urban ideation.

5) Impact assessment: After implementing the interventions, assess the impact on access to maternal health by comparing the utilization rates of delivery assistance before and after the interventions. This can be done by analyzing the data collected in step 1 and comparing the results to the baseline analysis conducted in step 2.

6) Evaluation: Evaluate the effectiveness of the interventions by analyzing the changes in utilization rates and assessing whether the interventions have successfully improved access to skilled health attendants. This evaluation can be done using statistical analysis techniques such as regression analysis or by comparing the results to predefined targets or benchmarks.

By following this methodology, it will be possible to simulate the impact of the recommended interventions on improving access to maternal health in Sokoto State. The results of this simulation can provide valuable insights for policymakers and program implementers to inform decision-making and further improve maternal health outcomes in the region.

Authors & Co-Authors

Statistics:

Citations: 24

Authors: 2

Identifiers:

DOI: 10.2147/IJWH.S54628

Research Areas:

Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Benin, Multi-Countries, Niger, Nigeria

Study Design:

Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Male & Female