Estimating the impact of trained midwives and upgraded health facilities on institutional delivery rates in Nigeria using a quasi-experimental study design

BMJ Open. 2022 May 24;12(5):e053792. doi: 10.1136/bmjopen-2021-053792.

Abstract

Objectives: Studies have shown that demand-side interventions, such as conditional cash transfers and vouchers, can increase the proportion of women giving birth in a health facility in low-income and middle-income countries, but there is limited evidence of the effectiveness of supply-side interventions. We evaluated the impact of the Subsidy Reinvestment and Empowerment Programme Maternal and Child Health Project (SURE-P MCH) on rates of institutional delivery and antenatal care.

Design, setting and participants: We used a differences-in-differences study design that compared changes in rates of institutional delivery and antenatal care in areas that had received additional support through the SURE-P MCH programme relative to areas that did not. Data on outcomes were obtained from the 2013 Nigerian Demographic and Health Survey.

Results: We found that the programme significantly increased the proportion of women giving birth in a health facility by approximately 7 percentage points (p=0.069) or approximately 10% relative to the baseline after 9 months of implementation. The programme, however, did not significantly increase the use of antenatal care.

Conclusion: The findings of this study suggest there could be important improvements in institutional delivery rates through greater investment in supply-side interventions.

Keywords: health economics; health policy; international health services; maternal medicine; public health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Female
  • Health Facilities
  • Humans
  • Maternal Health Services*
  • Midwifery*
  • Nigeria
  • Parturition
  • Pregnancy
  • Prenatal Care