Trends in delivery with no one present in Nigeria between 2003 and 2013

Figures & data

Figure 1 Conceptual framework of the systemic, household, and individual factors that impact attendance at birth.

Table 1 Variables used in the analysis

Variable	Definitions and reference groups (ref)
Year	2013; 2003; 2008 (ref)
Age (years)	15–24; 25–34; 35+ (ref)
Total number of live births	1; 2; 3; 4+ (ref)
Urban/rural residence	Urban; rural (ref)
Religion	Muslim; Christian/Catholic/Other (ref)
Region of residence	North Central; North East; North West; South East; South South; South West (ref)
Level of education	Primary, secondary, secondary +, none (ref)
Wealth quintile	NDHS wealth quintiles 1, poorest; 2; 3; 4; 5, richest (ref)
Employment status	Has worked in 12 months preceding the survey; not currently working (ref)
Attitudes toward intimate physical partner violence	Intimate partner violence is justified if a wife goes out without telling her husband; wife neglects her children; wife argues with her husband; a wife refuses to have sex with her husband or she burns food vs intimate partner violence is not permissible under any of the above circumstances (ref)
Women involved in health care decisions	Respondent is involved in decisions regarding her health, either alone, with a spouse or with another person; respondent is not involved in decisions regarding her health (ref)
Number of antenatal care visits in most recent pregnancy	Coded as 0, 1, 2, 3, 4, 5+ (used as a continuous predictor variable in the analyses)
Woman bought or was given iron tables or syrup during their most recent pregnancy	Yes; no (ref)
Woman stated that getting permission to seek health care was a big problem, when getting medical care for herself	Yes; no (ref)
Woman stated that the distance to a health facility was a big problem, when getting medical care for herself	Yes; no (ref)
Outcome variable	Birth with no one present; birth with any individual present, regardless of skill (ref)

Abbreviations: NDHS, Nigerian Demographic and Health Survey; ref, reference group.

Table 2 Weighted distribution of the analysis variables, by survey year, among married Nigerian women who had given birth in the 5 years preceding the survey

Variable	2003 (%)	2008 (%)	2013 (%)	χ^2
Gave birth alone (most recent birth)
Yes	17.55	20.11	14.04	<0.0001
No	82.45	79.89	85.96
Age (years)
15–24	29.38	24.42	24.64	0.0001
25–34	45.93	47.88	47.69
35+	24.70	27.70	27.67
Number of births
1	17.77	15.32	15.82	0.0093
2	14.68	16.55	16.40
3	13.75	15.77	15.23
4+	53.81	52.36	52.55
Cowifea
Yes	34.90	32.26	32.72	0.3538
No	65.10	67.74	67.28
Residence
Urban	28.20	30.19	34.84	0.0253
Rural	71.80	69.81	65.16
Religion
Muslim	13.50	57.24	64.13	<0.0001
Traditional/Christian/Catholic/Other	86.50	42.77	35.87
Region
North Central	14.85	14.44	14.62	<0.0001
North East	23.07	16.13	17.47
North West	36.89	32.04	38.41
Southern regions	25.19	37.39	29.50
Education
None	53.54	47.71	50.57	0.0003
Primary	22.95	22.20	18.84
Secondary	19.83	24.07	24.21
Higher	3.67	6.02	6.37
Wealth quintile
1 (poorest)	22.29	23.72	24.34	0.9442
2	21.91	22.44	22.81
3	20.95	18.52	18.21
4	18.27	17.55	17.30
5	16.58	17.77	17.34
Currently employed
Yes	63.64	63.78	64.47	0.4184
No	36.36	36.22	35.53
Attitudes toward intimate physical partner violenceb
Permissible in some circumstances	71.13	49.64	38.74	<0.0001
Never	28.87	50.36	61.26
Women involved in health care decisionsc
Yes	20.05	41.54	35.78	<0.0001
No (ref)	79.95	58.46	64.22
Number of antenatal care visits (continuous, range 0–5+), during most recent pregnancy
0	39.45	40.88	36.21	<0.0001
1	2.72	1.53	1.78
2	4.57	3.18	3.75
3	6.47	5.56	7.00
4	5.77	6.47	8.28
5+	41.02	42.38	42.98
Given or bought iron supplements during most recent pregnancy
Yes	58.37	54.84	62.98	<0.0001
No	41.63	45.16	37.02
Woman stated that getting permission to seek health care was a big problem, when getting medical care for herself
Yes	11.14	16.43	12.22	0.0003
No	88.86	83.57	87.78
Woman stated that the distance to a health facility was a big problem, when getting medical care for herself
Yes	26.05	40.05	31.77	<0.0001
No	73.95	59.95	68.23

Notes: Total sample size was 38,546: in 2003 the sample size was 3,410; in 2008 the sample size was 16,728; in 2013 the sample size was 18,408.

a Respondent was living in a household with cowives.

b Intimate partner violence is acceptable under any of the following conditions: wife goes out without telling her husband; wife neglects her children; wife argues with her husband; wife refuses to have sex with her husband, or she burns food.

c Respondent is involved in decisions regarding her health, either alone, with a spouse, or with another person.

Abbreviation: ref, reference group.

Figure 2 Percentage of married Nigerian women (who had given birth in the five years preceding the survey) who gave birth with no one present, by region.

Table 3 Trends in the percentage of married women, who had given birth in the 5 years preceding survey, who gave birth alone

State	2003 (%)	2008 (%)	2013 (%)	Percentage point difference between 2003 and 2013	Rate of decline over 10 years (%)
Sokoto	27	25	0	0.26	99
Zamfara	32	61	46	–0.15	–46
Katsina	24	62	27	–0.03	–11
Jigawa	41	28	22	0.19	46
Yobe	16	18	0	0.16	99
Borno	7	9	3	0.04	58
Adamawa	3	18	7	–0.05	–194
Gombe	14	14	16	–0.02	–17
Bauchi	26	36	21	0.05	20
Kano	38	59	41	–0.02	–6
Kaduna	29	6	16	0.14	47
Kebbi	20	55	27	–0.07	–36
Niger	23	19	6	0.16	71
FCT – Abuja	19	5	4	0.14	77
Nasarawa	9	9	12	–0.03	–37
Plateau	5	5	14	–0.08	–153
Taraba	35	11	10	0.25	72
Benue	5	2	7	–0.02	–40
Kogi	7	6	1	0.06	92
Kwara	6	30	1	0.05	83

Note: Data in bold show significance is expressed by the sheer magnitude of the change.

Abbreviation: FCT, Federal Capital Territory.

Table 4 Unadjusted odds ratios, by survey year, predicting married Nigerian women’s most recent birth (among women who had given birth in the 5 years preceding the survey) occurring with no one presenta

Variable	Unadjusted odds ratio	95% confidence limits
Year
2003	1.30	1.04, 1.64
2008	1.54	1.31, 1.82
2013 (ref)
Age (years)
15–24	0.67	0.61, 0.73
25–34	0.73	0.68, 0.79
35+ (ref)
Number of births
1	0.28	0.25, 0.32
2	0.50	0.46, 0.55
3	0.58	0.52, 0.63
4+ (ref)
Cowifeb
Yes	2.13	1.96, 2.31
No (ref)
Residence
Urban	0.32	0.26, 0.39
Rural (ref)
Religion
Muslim	4.36	3.73, 5.09
Traditional/Christian/Catholic/Other (ref)
Region
North Central	4.27	3.25, 5.60
North East	7.29	5.62, 9.47
North West	22.34	17.72, 28.15
Southern regions (ref)
Education
None (ref)
Primary	0.31	0.27, 0.35
Secondary	0.10	0.08, 0.12
Higher	0.02	0.01, 0.04
Wealth quintile
1 (poorest)	17.61	13.20, 23.49
2	12.42	9.36, 16.48
3	6.87	5.20, 9.07
4	3.30	2.52, 4.33
5 (ref)
Currently employed
Yes	0.70	0.64, 0.78
No (ref)
Attitudes toward intimate physical partner violencec
Permissible in some circumstances	1.40	1.26, 1.57
Never (ref)
Women involved in health care decisionsd
Yes	0.28	0.25, 0.32
No (ref)
Number of antenatal care visits, during most recent pregnancy
0	6.73	5.83, 7.76
1	2.79	2.14, 3.65
2	2.83	2.29, 3.50
3	2.35	1.97, 2.80
4	2.02	1.71, 2.38
5+ (ref)
Given or bought iron supplements during most recent pregnancy
Yes	0.27	0.24, 0.31
No (ref)
Woman stated that getting permission to seek health care was a big problem, when getting medical care for herself
Yes	1.80	1.59, 2.04
No
Woman stated that the distance to a health facility was a big problem, when getting medical care for herself
Yes	1.47	1.30, 1.66
No

Notes:

a “Births alone” indicates that the most recent birth was assisted by no one. n=38,546. C=0.82.

b Respondent was living in a household with cowives.

c Intimate partner violence is acceptable under any of the following conditions: wife goes out without telling her husband; wife neglects her children; wife argues with her husband; wife refuses to have sex with her husband, or she burns food.

d Respondent is involved in decisions regarding her health, either alone, with a spouse, or with another person.

Abbreviation: ref, reference group.

Table 5 Adjusted odds ratios, by survey year, predicting married Nigerian women’s most recent birth (among women who had given birth in the 5 years preceding the survey) occurring with no one presenta

Variable	Adjusted odds ratio	95% confidence limits
Year
2003	2.19	1.72, 2.80
2008	2.05	1.76, 2.38
2013 (ref)
Age (years)
15–24	0.81	0.70, 0.92
25–34	0.85	0.78, 0.93
35+ (ref)
Number of births
1	0.34	0.29, 0.40
2	0.70	0.61, 0.79
3	0.77	0.69, 0.86
4+ (ref)
Cowifeb
Yes	1.15	1.05, 1.25
No (ref)
Residence
Urban	1.03	0.84, 1.26
Rural (ref)
Religion
Muslim	1.60	1.34, 1.91
Traditional/Christian/Catholic/Other (ref)
Region
North Central	2.29	1.77, 2.96
North East	2.24	1.70, 2.94
North West	6.78	5.23, 8.80
Southern regions (ref)
Education
None (ref)
Primary	0.24	0.14, 0.40
Secondary	0.66	0.54, 0.80
Higher	0.24	0.14, 0.40
Wealth quintile
1 (poorest)	3.10	2.25, 4.25
2	2.52	1.86, 3.40
3	2.20	1.65, 2.94
4	1.57	1.19, 2.07
5 (ref)
Currently employed
Yes	1.16	1.04, 1.30
No (ref)
Attitudes toward intimate physical partner violencec
Permissible in some circumstances	0.91	0.81, 1.02
Never (ref)
Women involved in health care decisionsd
Yes	0.75	0.66, 0.86
No (ref)
Number of antenatal care visits, during most recent pregnancy	0.88	0.85, 0.91
Given or bought iron supplements during most recent pregnancy
Yes	1.05	0.91, 1.20
No (ref)
Woman stated that getting permission to seek health care was a big problem, when getting medical care for herself
Yes	0.95	0.82, 1.10
No
Woman stated that the distance to a health facility was a big problem, when getting medical care for herself
Yes	0.93	0.82, 1.06
No

Notes:

a “Births alone” indicates that the most recent birth was assisted by no one. n=38,546; all analyses were adjusted for survey design, sampling errors, and uneven weights using the SAS v. 9.2 survey procedures. C=0.82.

b Respondent was living in a household with cowives.

c Intimate partner violence is acceptable under any of the following conditions: wife goes out without telling her husband; wife neglects her children; wife argues with her husband; wife refuses to have sex with her husband, or she burns food.

d Respondent is involved in decisions regarding her health, either alone, with a spouse, or with another person.

Abbreviation: ref, reference group.

Table 6 Distribution of where most recent birth occurred by region, in married women with at least one birth in the years preceding the survey

Variable	2003 (%)	2008 (%)	2013 (%)	Percentage point difference between 2003 and 2013
North Central
Non-facility	53.78	58.00	53.00	−0.78
Public	27.38	27.75	31.45	4.07
Private	18.84	13.97	15.50	−3.34
North East
Non-facility	81.67	86.51	79.90	−1.77
Public	15.66	12.61	18.83	3.17
Private	2.78	0.89	1.27	−1.51
North West
Non-facility	89.29	91.02	87.52	−1.77
Public	9.08	8.09	11.97	2.89
Private	1.63	0.90	0.52	−1.11
Southern regions
Non-facility	32.03	33.40	28.16	−3.87
Public	29.55	32.88	36.27	6.72
Private	38.41	37.72	34.57	−3.84

Table 7 Percentage of women who took iron tablets or syrup in zones, in 2003–2013, and prevalence of women giving birth with NOP, prevalence by region

Region	2003	2008	2013	Percent difference between 2003 and 2013 (%)	NOP in 2013 (%)
North West	40.6	30.6	43.9	8	28
North East	54.4	46	61.7	13	10
North Central	58.7	50.3	71.4	22	7

Abbreviation: NOP, no one present.