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

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 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 rates 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-value 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. Funding: Bill & Melinda Gates Foundation and the Strategic Impact Evaluation Fund