Overview on the level of institutional delivery

The health of mothers and children is central to global and national concerns, and improvements in maternal and child survival are two important Millennium Development Goals. Apart from the obvious linkages between health programs, mother and child health is intimately bound up with economic development, education, gender issues and rights. Although most pregnancies and births are uneventful, approximately 15% of all pregnant women develop a potentially life-threatening complication that calls for skilled care and some will require a major obstetrical intervention which demands institutional delivery to survive.

According to a joint study done by WHO and other organisation, in the year of 2008, 358, 000 maternal deaths occurred globally from preventable complications that took place during pregnancy and childbirth. Of these deaths, the majority (99 percent) of the maternal death occurred in developing countries, and 87 percent of the total death occurred in South Asia and Sub-Sahara Africa (countries in Africa under Sahara desert in which Ethiopia is also situated). These numbers clearly indicate that from the total number of death that occurs in the world a vast majority occurs in countries like Ethiopia. Similar studies done by WHO in 2011 also reported that the proportion of deliveries attended by skilled health providers rose from 58 percent in 1990 to 68 percent in 2008 worldwide, but remained at only about 50 percent in Africa. This number indicates to you that despite the high number of maternal death rate, the number of deliveries which are attended by skilled health provider is not increasing.

If you still see some more findings, you will find that each year in Africa, 30 million women become pregnant, and 18 million give birth at home without skilled care from a trained health professional. As a consequence, every year over 250,000 African women dies because of factors related to their pregnancy and childbirth (Save the Children, USAID, UNFPA, UNICEF, WHO, Opportunities for Africa's Newborns: Practical Data, Policy and Programmatic Support for Newborn Care in Africa, 2006).

Most pregnant women in the developing world like Ethiopia receive insufficient or no prenatal care and deliver without help from appropriately trained health care providers and hence, more than 7 million newborn deaths are believed to result from maternal health problems and their mismanagement.

Perinatal mortality tends to follow the same geographical pattern as for maternal deaths. Stillbirths, neonatal deaths, and maternal morbidity and mortality fit together as public health priorities. A very large proportion of maternal and perinatal deaths are avoidable. When you see most of these deaths, their occurrence relate in one or another way with not utilising the healthcare facility or attending institutional delivery with skilled professional. Institutional delivery is a delivery attended by a skilled health professional in a healthcare facility.

Ethiopia, being one of the developing countries, faces a high burden of morbidity and mortality from poor maternal and child health outcomes. The maternal mortality (676/100,000) and under-five mortality (88/1,000) rates of the country are unacceptably high, and only 10% of mothers deliver with a skilled birth attendant (DHS 2011). Some evidence explains that this poor health status is exhibited among women because a vast majority of women in the country do not have access to or do not utilise health services. As you can see from the above figures, a great proportion of women are still giving birth in their home which in turn could result in higher morbidity and mortality of mothers and infants. For most women in the developing countries like Ethiopia, lack of regular access to health services, has greatly contributed to the high rate of morbidity and mortality. Most mothers receive minimal or none Antenatal care (ANC) and worst of all, deliver without access to skilled obstetrical care when complications develop.

The proportion of births that occur at home remains high in Ethiopia, and skilled health professionals attend very few births even compared with other African countries. According to DHS 2011 study, institutional delivery is notably low in the Ethiopia despite recent improvements. The study result in the Table below indicates that, assistance at delivery by health worker was quite low at 13.2% in 2011 although this has increased significantly from the previous rate of 6.2% in 2000. On top of that, the study also indicated that 99% of home deliveries were not assisted by any health worker, and there is an increase in the proportion of deliveries assisted by families, friends or neighbours.