How many births in sub-Saharan Africa and South Asia will not be attended by a skilled birth attendant between 2011 and 2015?

Abstract

Background: The fifth Millennium Development Goal target for 90% of births in low and middle income countries to have a skilled birth attendant (SBA) by 2015 will not be met. In response to this, policy has focused on increasing SBA access. However, reducing maternal mortality also requires policies to prevent deaths among women giving birth unattended. We aimed to generate estimates of the absolute number of non-SBA births between 2011 and 2015 in South Asia and sub-Saharan Africa, given optimistic assumptions of future trends in SBA attendance. These estimates could be used by decision makers to inform the extent to which reductions in maternal mortality will depend on policies aimed specifically at those women giving birth unattended.

Methods: For each country within South Asia and sub-Saharan Africa we estimated recent trends in SBA attendance and used these as the basis for three increasingly optimistic projections for future changes in SBA attendance. For each country we obtained estimates for the current SBA attendance in rural and urban settings and forecasts for the number of births and changes in rural/urban population over 2011-2015. Based on these, we calculated estimates for the number of non-SBA births for 2011-2015 under a variety of scenarios.

Results: Conservative estimates are that there will be between 130 and 180 million non-SBA births in South Asia and sub-Saharan Africa from 2011 to 2015 (90% of these in rural areas). Currently, there are more non-SBA births per year in South Asia than sub-Saharan Africa, but our projections suggest that the regions will have approximately the same number of non-SBA births by 2015. We also present results for each of the six countries currently accounting for more than 50% of global maternal deaths.

Conclusions: Over the next five years, many millions of women within South Asia and sub-Saharan Africa will give birth without an SBA. Efforts to improve access to skilled attendance should be accompanied by interventions to improve the safety of non-attended deliveries.

Figure 1

Methodological steps. The methodological steps performed in the analysis for each country and each fertility assumption. Data inputs are indicated with shaded boxes, while outputs are indicated with a bold border. *Note that we additionally considered more optimistic projections for trends in SBA attendance from the end of 2010 onwards, based on scaling multiples of recent trends; see text for more details.

Figure 2

Non-SBA birth projections. Projections for the estimated number of non-SBA births in South Asia and sub-Saharan Africa during the period 2011-2015 inclusive for the six scenarios set out in Table 1. Total non-SBA births over both regions are given to the nearest 5 million. In all scenarios, at least 90% (85%) of estimated non-SBA births were in rural areas for South Asia (sub-Saharan Africa). Note that we were not able to calculate estimates for Senegal, Mayotte, Seychelles and Tanzania.

Figure 3

Non-SBA projections over time. Estimated total annual number of non-SBA attended births over the period 2011-2015 (inclusive) for scenario 5: optimistic trend in SBA births, low fertility.