Skilled birth attendance in Sierra Leone, Niger, and Mali: analysis of demographic and health surveys

BACKGROUND: Skilled birth attendance (SBA) is a key strategy for averting maternal mortality ratio (MMR). The lifetime risk of maternal death is high in countries with low SBA. With the presence of a skilled birth attendant, the possibility of death owing to intrapartum-related complications or stillbirth can be reduced by 20%. METHODS: Using data from the most recent Demographic and Health Surveys, we investigated the prevalence of skilled birth attendance, variations, and associated factors. The sample was drawn from women aged 15–49 who were surveyed in these countries as part of the Demographic and Health Survey (DHS) program. With multivariate logistic regression, we explored the socio-demographic factors that predict women’s likelihood of seeking skilled birth attendance or otherwise. RESULTS: Less than half of the women in Niger, Sierra Leone, and Mali obtained skilled birth attendance, with the worst case occurring in Niger (32.6%). Women in rural areas have less likelihood of obtaining skilled birth attendance (OR 0.21; 95% CI 0.16–0.28), as compared to women in urban locations. Highly educated women (OR 2.50; 95% CI 0.72–8.69), those who had subscribed to health insurance (OR 1.39; 95% CI 0.88–2.20), those who obtain four or more antenatal care visits (OR 1.63; 95% CI 1.43–1.86), and women who watch television at least once a week (OR 2.33; 95% CI 1.88–2.88) are more probable to seek SBA. CONCLUSION: Interventions to increase SBA rates in these countries need to be reassessed to focus on the rural-urban disparity in healthcare, female education, and ANC attendance.