The Better Obstetrics in Rural Nigeria (BORN) Study

Pregnancy-related morbidity and mortality have serious economic and social consequences. The Midwives Service Scheme (MSS) was introduced in 2009 to provide round-the-clock access to skilled care in rural underserved areas of Nigeria. At rollout, the MSS deployed nearly 2,500 midwives to 652 primary health care centers across 36 states. To evaluate the impact of the program, the researchers surveyed 7,104 women in 386 communities across 12 states and conducted in-depth interviews and focus group discussions with policymakers, providers, childbearing women, and community stakeholder groups in three states. They compared changes in pregnancy and birth outcomes in MSS areas to changes in comparison areas over the same period. They found a 12 percent increase in antenatal care use in program clinics and a 6 percent increase in overall use of antenatal care, both in the first year of the program. They also found suggestive but not conclusive evidence of a small increase in skilled birth attendance that was largely confined to the south where there were fewer challenges with maintaining supply of midwives. They found no improvements in maternal or child health. The researchers found that while the deployment of midwives initially increased access to skilled care, this eroded over time, potentially explaining why initial improvements were not sustained. Such problems as difficulties associated with relocating to new areas, inadequate provision of housing accommodation, and irregular payment of salaries (which worsened over time) contributed to midwives wanting to leave the scheme.