Skilled birth assistance in Nigeria: A function of frequency and content of antenatal care

Background: Antenatal care (ANC) is relevant to the prevention of maternal deaths especially in Nigeria, which is one of the two countries with the highest absolute number of maternal deaths in the world. With a maternal mortality ratio (MMR) of 630 deaths per 100,000 live births, evidence suggests that MMR can be reduced by improving access to ANC and skilled birth assistance (SBA). Hence, this study aims to examine the association between ANC and SBA in Nigeria.

Methods: This study used data collected from a representative sample of women, aged 15-49, during a household cross-sectional survey in Nigeria in 2011. Study sample is restricted to women who were within two years postpartum (weighted n=9879). The three-delay framework was used as a conceptual model to identify the covariates included in the regression models. Multivariate logistic regression was used to assess the association between ANC (operationalized as number of visits attended and number of services received during last pregnancy) and SBA.

Results: While about 70% of the women received any ANC (visit and/or service) during their last pregnancy, only half (49%) had SBA during their last childbirth. The number of ANC services received, rather than the number of ANC visits attended, during pregnancy was positively associated with having SBA during last birth after controlling for relevant covariates (OR: ≥3.0; p<0.05).

Implication/Conclusion: To correctly estimate the ANC coverage in any community, the right indicator should be measured. In revising the recommended indicator for ANC coverage, contextual and regional influences should be accounted for.