Factors influencing the selection of delivery with no one present in Northern Nigeria: implications for policy and programs

Figures & data

Figure 1 Age distribution of live births in 5 years preceding the Nigeria 2008 Demographic and Health Survey.

Note: Data from National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.¹

Table 1 Description of outcome and predictor variables

Variables	Variable description
Sociodemographic variables
Mother’s age at birth	Measured in 5-year intervals: ≤19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49 years.
Birth order	Grouped data, measuring the sequencing of births from the first to the last. First births were coded 1, second 2, and so on. All births in the fifth or higher position were categorized into the fifth birth order.
Residence (rural/urban)	Coded as 1 if residence is urban and as 0 if residence is rural.
Mother’s education	Coded 1 if mothers reported that they had attained some/completed primary education and 2 if women had attained some/completed secondary education or higher, otherwise it was coded 0.
Wealth quintile	Measured using ownership of household consumables; infrastructure (eg, building type, water, electricity, toilet facilities); small equipment (eg, telephone, TV); and large equipment (bikes, cars, etc). Items were coded into a relative index of household wealth, calibrated into quintiles, each representing 20% of the score, from quintile 1 (poorest) to quintile 5 (richest).
Religion	Coded 1 if mothers reported they were Muslim and 0 if they were Christians or affiliated with other religions.
Woman’s employment	Current work status was coded 1 if mothers said they were working at the time of survey, otherwise it was coded 0.
Women’s autonomy factors
Participation in decision-making	Measured using four elements of household decision-making, expected to involve husband/wife participation: decisions regarding purchase of large household goods; purchases of daily needs; mother’s health care; and how to spend money husbands earned. Coded 1 if a mother said she decided all four issues alone or jointly with her husband (full participation); otherwise the indicator was coded 0 (little or no participation).
Disapproval of inequity-perpetuating gender norms	Measured by three variables: (1) co-wife status, (2) disapproval of wife beating, and (3) approval of wife’s control over their own sexuality.
	Co-wives was coded 1 if a woman reported that her husband had other wives, which means the respondent was polygynously married. Otherwise, the variable was coded 0.
	Disapproval of wife-beating was coded 1 if the mother said a wife should not be beaten under any of the following circumstances: wife goes out without telling her husband; wife neglects her children; and wife argues with her husband or burns food. Otherwise, this was coded 0, indicating approval of wife-beating.
	Approval of wife’s sex autonomy was measured with two indicators: the first was coded 1 if mothers reported that a wife was justified to refuse sex if her husband had a sexually transmitted infection or had sex with other women, otherwise the indicator was coded 0. The second indicator was coded 1 if a mother said that a wife was justified to refuse sex if she was tired or not in the mood, otherwise it was coded 0.
Outcome variable	The type of delivery assistance received by mothers during any live births in 5 years preceding the Nigeria 2008 Demographic and Health Survey^Citation1 (ie, 2003–2008) was coded 1 if the index birth was attended by skilled assistants, 2 if by unskilled assistants, and 3 if no one attended the delivery. Skilled assistants included medical; doctors, nurses/midwives, and auxiliary nurses/midwives. Unskilled assistants were traditional birth attendants and relatives/friends. Births delivered with no attendant were also described as deliveries with no one present or as no-one-present deliveries.

Table 2 Socioeconomic differentials in live births in 5 years before the Nigeria 2008 Demographic and Health Survey, Sokoto State, Nigeria

Characteristic	Unweighted live births in 5 years preceding survey	Weighted %	95% CI
			From	To
Birth order
1st birth	171	15.7	15.700	15.705
2nd birth	179	16.4	16.434	16.440
3rd birth	169	15.5	15.516	15.521
4th birth	129	11.8	11.844	11.848
5th birth or higher	441	40.5	40.493	40.498
Current work status
Currently working	669	61.4	61.429	61.436
Not working	420	38.6	38.564	38.571
Education
No education	986	90.5	90.540	90.544
Primary	76	7	6.977	6.980
Secondary+	27	2.5	2.478	2.480
Residence
Rural	972	89.2	89.254	89.258
Urban	117	10.7	10.742	10.746
Religion
Christian/other	18	1.6	1.652	1.654
Islam	1,071	98.3	98.346	98.348
Wealth quintile
Poorest	393	36.1	36.085	36.089
Poorer	463	42.5	42.512	42.519
Poor	111	10.2	10.190	10.195
Richer	83	7.6	7.620	7.623
Richest	39	3.6	3.580	3.582
Total	1,089	100

Note: Data from National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.¹

Abbreviation: CI, confidence interval.

Table 3 Differentials in live births by mother’s autonomy characteristics, Sokoto State, Nigeria, Nigeria 2008 Demographic and Health Survey

Characteristic	Unweighted live births in 5 years preceding survey	Weighted %	95% CI
			From	To
Husband has other wives
Yes	432	39.7	39.666	39.667
No	657	60.3	60.327	60.334
Decision-making autonomy
Wife participates in any one of six decision elements	311	28.6	28.555	28.561
Wife participates in no decisions	778	71.4	71.439	71.445
Attitudes toward wife-beating
Never ok to beat wife for any reason	349	32.0	32.044	32.050
Ok to beat wife for at least one reason	740	68.0	67.949	67.955
Wife’s sex autonomy
Wife can refuse sex if husband has STD or sex with other women	792	72.7	72.724	72.730
Wife can refuse sex if wife is tired or not in the mood	273	25.1	25.066	25.072
Women cannot refuse sex for any reason	24	2.2	2.203	2.205
Total	1,089	100

Note: Data from National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.¹

Abbreviations: CI, confidence interval; STD, sexually transmitted disease.

Figure 2 Distribution of deliveries with no one present (NOP) in 5 years preceding the Nigeria 2008 Demographic and Health Survey by mother’s age, Sokoto State, Nigeria.

Note: Data from National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.¹

Figure 3 Socioeconomic differentials in births delivered with no one present in 5 years preceding the Nigeria 2008 Demographic and Health Survey, Sokoto State, Nigeria.

Note: Data from National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.¹

Figure 4 Distribution of live births by delivery assistance received in 5 years preceding the Nigeria 2008 Demographic and Health Survey, Sokoto State, Nigeria.

Note: Data from National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.¹
Abbreviation: TBA, traditional birth attendant.

Figure 5 Distribution of live births in 5 years preceding the Nigeria 2008 Demographic and Health Survey by mother’s age and type of delivery assistance, Sokoto, Nigeria.

Note: Data from National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.¹
Abbreviation: TBA, traditional birth attendant.

Table 4 Delivery assistance in 5 years preceding the Nigeria 2008 Demographic and Health Survey by socioeconomic characteristics, Sokoto State, Nigeria

Characteristic	Unweighted live births in 5 years preceding survey	Weighted %	Weighted % using specific delivery assistance
			No one present	Skilled assistant	TBA	Friends/family/other	Total	Chi-square (P<0.05)
Birth order								40.00**
1st birth	171	15.7	12.3	8.2	67.8	11.7	100
2nd birth	179	16.4	22.9	5.6	67.6	3.9	100
3rd birth	169	15.5	30.2	4.7	63.9	1.2	100
4th birth	129	11.8	30.2	3.9	62.8	3.1	100
5th birth or higher	441	40.5	29.0	4.5	62.6	3.9	100
Residence								92.00**
Rural	972	89.3	27.2	3.1	66	3.7	100
Urban	117	10.7	13.7	23.1	51.3	12	100
Religion								3.50**
Christian/other	18	1.7	38.9	5.6	44.4	11.1	100
Islam	1,071	98.3	25.5	5.2	64.8	4.5	100
Education								47.00**
No education	986	90.5	26.2	4.4	65.4	4.0	100
Primary	76	7.0	25	6.6	59.2	9.2	100
Secondary+	27	2.5	11.1	33.3	44.4	11.1	100
Wealth quintile								130.00**
Poorest	393	36.1	30.8	2.3	62.9	4	100
Poorer	463	42.5	24.6	2.8	68.9	3.7	100
Poor	111	10.2	23.4	4.5	67.6	4.5	100
Richer	83	7.6	20.5	18.1	49.4	12	100
Richest	39	3.6	5.3	38.5	51.3	5.1	100
Total	1,089	100	25.7	5.2	64.5	4.6	100

Notes:

** Estimates are significant at 0.05 alpha level, notated as (P<0.05). Data from National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.¹

Abbreviation: TBA, traditional birth attendant.

Table 5 Distribution of live births with specific delivery assistances by mother’s autonomy characteristics, Sokoto State, Nigeria, Nigeria 2008 Demographic and Health Survey

Characteristic	Unweighted live births in 5 years preceding survey	Weighted %	Weighted % using specific delivery assistance
			No one present	Skilled assistant	TBA	Friends/family/other	Totals	Chi-square (P<0.05)
Current work								4.00**
Currently working	669	61.4	23.9	6.0	65.7	4.9	100
Not working	420	38.6	28.6	4.0	63.3	4.0	100
Husband has other wives								2.10**
Yes	432	39.7	25.9	4.4	66.0	3.7	100
No	657	60.3	25.6	5.8	63.5	5.2	100
Decision-making autonomy								140.00**
Fully participating in at least one item	311	28.6	45.0	4.8	37.9	12.2	100
Not participating in any decisions	778	71.4	18.0	5.4	75.1	1.5	100
Attitudes toward wife-beating								36.00**
Never ok to beat wife for any reason	349	32.0	14.9	7.7	74.5	2.9	100
Ok to beat wife for at least one reason	740	68.0	30.8	4.0	59.7	5.4	100
Wife’s sex autonomy								111.00**
Wife can refuse sex if husband has STD/sex with other women	792	72.7	20.1	4.3	73.6	2.0	100
Wife can refuse sex if tired/not in the mood	273	25.1	41.8	7.7	39.2	11.4	100
Wife has no right to refuse sex if tired/not in the mood	24	2.2	29.2	8.3	50.0	12.5	100
Total	1,089	100	25.7	5.2	64.5	4.6	100

Notes:

** Estimates are significant at 0.05 alpha level, notated as (P<0.05). Data from National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.¹

Abbreviations: TBA, traditional birth attendant; STD, sexually transmitted disease.

Table 6 Influential factors in the use of delivery attendants in Sokoto State, Nigeria, Nigeria 2008 Demographic and Health Survey

Characteristics	Logistic regression of deliveries with no one present versus use of other delivery approaches (Model 1)	Multinomial logistic regression comparing delivery with no one present and skilled attendance with unskilled attendance
		No one present versus unskilled attendance (Model 2)	Skilled versus unskilled attendance (Model 3)
Age (years)
≤24	Reference	Reference	Reference
25–29	1.93**	2.04**	2.41**
30–34	1.20**	1.28**	2.76**
35+	1.51**	1.56**	2.16**
Birth order
1st birth	Reference	Reference	Reference
2nd birth	2.08**	2.01**	0.59**
3rd birth	2.91**	2.76**	0.41**
4th birth	2.64**	2.44**	0.28**
5th or higher	2.95**	2.69**	0.23**
Mother’s work status
Not working	Reference	Reference	Reference
Working	0.58**	0.58**	1.21**
Education
No education	Reference	Reference	Reference
Primary/secondary education	0.83**	0.87**	1.57**
Residence
Rural	Reference	Reference	Reference
Urban	0.39**	0.41**	1.16**
Wealth quintile
Poorest	Reference	Reference	Reference
Poorer	0.92**	0.93**	0.98**
Poor	0.85**	0.87**	1.89**
Rich	0.83**	1.09**	10.78**
Husband has other wives
No	Reference	Reference	Reference
Yes	0.85**	0.81**	0.53**
Decision-making autonomy
Limited or no involvement in decisions regarding household expenses and health-seeking decisions	Reference	Reference	Reference
Fully involved in household expenses and health-seeking decisions	0.68**	0.58**	0.23**
Attitudes toward wife-beating
Ok to beat wife for at least one reason	Reference	Reference	Reference
Never ok to beat wife	0.49**	0.51**	1.87**
Wife’s sex autonomy (1)
Wife has no right to refuse sex if husband has STD/sex with other women	Reference	Reference	Reference
Wife has right to refuse sex if husband has STD/sex with other women	0.68**	0.62**	0.24**
Wife’s sex autonomy (2)
Wife cannot refuse sex if tired or not in the mood	Reference	Reference	Reference
Wife can refuse sex if tired or not in the mood	3.24**	3.40**	2.34**

Notes: Estimates are odds ratio.

** P<0.01. Data from National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.¹

Abbreviation: STD, sexually transmitted disease.

National Population Commission (NPC) [Nigeria], ICF MacroNigeria Demographic and Health Survey 2008Abuja, NigeriaNPC, ICF Macro2009

 Google Scholar