To ensure that women have ready and affordable access to skilled attendance at delivery	Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

The challenge

Insufficient maternal care during pregnancy and delivery is largely responsible for the staggering annual toll of more than half a million maternal deaths and the estimated 4 million newborn deaths that occur within the first month of life. Indeed, roughly three quarters of all maternal deaths occur during delivery and in the immediate post-partum period.

The single most critical intervention for safe motherhood is thus to ensure that women receive care during delivery by skilled health personnel – a doctor, nurse or midwife – with the necessary skills to handle normal deliveries safely, to recognize the onset of complications beyond their capacity and to refer the mother for emergency care as needed. Traditional birth attendants, whether trained or untrained, can neither predict nor cope with serious complications.
 
All women should have access to basic maternity care through a continuum of services offering quality antenatal care, clean and safe delivery, and post-natal care for mother and infant, with a functioning referral system linking the whole. The quality of care provided by health personnel is crucial. Particularly when complications occur, skilled personnel need access to essential drugs, supplies, equipment and emergency obstetric care. They should receive training on required competencies. And they need supervision that helps ensure high standards of care, which is vitally important.

Coverage in skilled attendance at delivery varies by region

Overall, 63 per cent of births in developing countries are attended by skilled health personnel. Sub-Saharan Africa and South Asia, which bear the greatest burden of maternal mortality, also have the lowest levels of skilled birth attendance. Just half of births in West and Central Africa and less than 50 per cent of births in South Asia and Eastern and Southern Africa are delivered with a doctor, nurse, midwife or auxiliary midwife in attendance. By contrast, more than 90 per cent of deliveries in Central snd Eastern Europe/Commonwealth of Independent States (CEE/CIS), East Asia and Pacific and Latin America and Caribbean countries are attended by skilled personnel.

              

Source:  MICS, DHS and other national surveys, 2003-2008. 

It is important to note that in many countries, particularly in middle- and high-income countries, a large number of births also occur in health facilities, and thus are attended by skilled health personnel with greater access to appropriate equipment and supplies. For example, almost all deliveries in CEE/CIS (93 per cent) and in Latin America and the Caribbean (88 per cent) occur in health facilities. In sub-Saharan Africa and South Asia, however, less than half of deliveries occur in health facilities (42 per cent and 35 per cent of deliveries, respectively).

There are substantial disparities in delivery care. In developing countries, just 50 per cent of births in rural areas are attended by skilled health personnel compared with 83 per cent in urban areas. Some of the greatest differentials can be seen in South Asia and sub-Saharan Africa where women in urban areas are more than twice as likely as women in rural areas to deliver with a skilled health professional in attendance.  

Increasing coverage in skilled attendance at delivery

Based on a subset of countries with trend data, all developing regions have increased their coverage of skilled delivery attendance since 1990, with a particularly marked increase in South Asia (a 54 per cent increase), West and Central Africa and Middle East and North Africa (29 per cent increase each).

Skilled attendant at delivery coverage has increased in all regions since 1990
Percentage of births delivered by a doctor, nurse, midwife or auxiliary midwife

References