In recent years, a concerning trend has emerged across Sub-Saharan Africa that threatens decades of progress in maternal health: the pervasive reliance on non-institutional delivery methods. A comprehensive study by Oyedele and Lawal (2025) sheds new light on the global dominance of home births and traditional birth attendance in 25 Sub-Saharan African countries, linking this practice directly to alarming spikes in maternal mortality rates. Their research reveals a stark, often overlooked public health crisis, exposing the urgent need for systemic changes in maternal healthcare infrastructure and policy.
Non-institutional delivery—defined as childbirth occurring outside the oversight of certified medical facilities and skilled birth attendants—remains the predominant mode of delivery in many Sub-Saharan African communities. Despite global efforts to promote facility-based births, cultural norms, geographic isolation, economic constraints, and mistrust in health systems perpetuate this pattern. The study poignantly illustrates how these factors collectively undermine maternal safety and contribute to preventable deaths during childbirth.
The researchers embark on a thorough analysis of the epidemiological data collected over the past decade from 25 countries spanning West, East, and Southern Africa. The data elucidate a compelling correlation between the rates of non-institutional deliveries and maternal mortality ratios (MMRs). Countries where more than 60% of births occur outside institutional settings exhibit maternal mortality ratios exceeding global averages by a significant margin, sometimes doubling or tripling the risk compared to countries with higher facility delivery rates.
A critical driver underpinning the persistence of non-institutional deliveries relates to access disparities. Rural populations, often facing inadequate transportation infrastructure and limited health service availability, are disproportionately affected. This geographic inequity means that pregnant women may opt for home births assisted by traditional birth attendants (TBAs) or family members, despite the known risks associated with lack of emergency obstetric care. Oyedele and Lawal’s study quantifies the scale of this access challenge, associating it not just with mortality but also with severe morbidity outcomes such as obstetric fistula, hemorrhages, and infection.
Beyond logistical hindrances, socio-cultural determinants play a pivotal role. Deep-rooted beliefs about childbirth as a natural process suitable for home environments, skepticism toward biomedical interventions, and gender dynamics that restrict decision-making power for women further entrench non-institutional deliveries. Oyedele and Lawal highlight ethnographic accounts that illustrate how trust in traditional practitioners often surpasses faith in formal health facilities, which can be perceived as inhospitable or culturally insensitive.
The research underscores a compounding effect where health system deficiencies exacerbate maternal risks. Poorly staffed clinics, irregular availability of skilled birth attendants, and shortages of essential medical supplies dissuade women from seeking institutional care. Moreover, the lack of antenatal education and inadequate emergency referral systems mean that when complications arise during a non-institutional delivery, the window for effective intervention often closes too rapidly for survival.
Oyedele and Lawal’s analysis also explores the economic dimensions of non-institutional births. Direct costs such as facility fees, transportation expenses, and indirect costs including lost labor opportunities disfavor institutional deliveries. In low-income settings where out-of-pocket healthcare expenditure remains high, families weigh the immediate economic burden against the perceived benefits, frequently opting for the more affordable and familiar home birth option.
The spike in maternal mortality linked to home deliveries is not merely a health issue but a multifaceted societal challenge. The consequences ripple through communities, affecting family structures, child health, and economic productivity. The study vividly captures narratives of mothers lost during childbirth and the grief of families who face the dual blow of losing a parent and the economic sustenance that mother provided.
At the heart of Oyedele and Lawal’s findings is a call for a paradigm shift in global health policy approaches. Interventions must integrate community engagement, recognize the legitimacy of traditional birth attendants, and create inclusive strategies that do not alienate women from vital medical care. Training TBAs as frontline collaborators and embedding them within referral networks could serve as a pragmatic compromise in contexts where institutional deliveries remain unattainable for the foreseeable future.
Technological innovations offer promising avenues to mitigate risks. Mobile health platforms capable of delivering maternal education, tracking pregnancy progress, and facilitating emergency communication could bridge some of the existing service gaps. Furthermore, leveraging data analytics to pinpoint high-risk regions enables targeted deployment of resources and personnel, maximizing impact while minimizing wasted efforts.
From a broader epidemiological perspective, the study importantly addresses the feedback loop wherein high maternal mortality rates reduce community confidence in health services, thus perpetuating reliance on non-institutional options. Breaking this cycle demands sustained investment in quality improvement within health systems, emphasizing respectful maternity care, infrastructure development, and training to enhance competence and empathetic patient interactions.
In addition to policy reforms, addressing social determinants of health is paramount. Improving women’s education, economic empowerment, and decision-making autonomy correlates strongly with increased institutional delivery rates. Oyedele and Lawal’s research advocates for multifactorial interventions combining healthcare access improvements with community-level empowerment initiatives.
Their work also extends to discussing the implications of COVID-19, which has strained health systems and disrupted antenatal care and delivery services globally. The pandemic exacerbated existing disparities, pushing more women to resort to home births, thereby potentially accelerating the maternal mortality spike observed in the studied countries. The authors urge that pandemic recovery strategies prioritize maternal health reinstatement as a key component.
While the gravity of the problem is clear, the study emphasizes that progress is achievable. Countries with concerted efforts to integrate community health workers, expand emergency obstetric care, and enforce maternal health policies have demonstrated measurable declines in maternal deaths linked to non-institutional births. These success stories provide roadmaps for scaling similar models elsewhere.
In conclusion, Oyedele and Lawal’s investigation reveals a silent global emergency unfolding in Sub-Saharan Africa: the dominance of non-institutional deliveries is fueling an alarming rise in maternal mortality. This multifaceted challenge demands urgent, nuanced, and culturally sensitive responses blending health system strengthening, community engagement, and socioeconomic development. Without swift action, the goal of reducing maternal deaths worldwide remains elusive.
The study’s meticulous data analysis serves as a clarion call not only to governments and international health organizations but also to the scientific community at large. Only through interdisciplinary collaboration and sustained commitment can the perilous trajectory of maternal health in these regions be reversed, safeguarding the lives and futures of millions of mothers and their families.
Subject of Research: The global prevalence of non-institutional delivery and its impact on the increasing maternal mortality rates in 25 Sub-Saharan African countries.
Article Title: Global dominance of non-institutional delivery and the risky impact on maternal mortality spike in 25 Sub-Saharan African Countries.
Article References:
Oyedele, O.K., Lawal, T.V. Global dominance of non-institutional delivery and the risky impact on maternal mortality spike in 25 Sub-Saharan African Countries. glob health res policy 10, 10 (2025). https://doi.org/10.1186/s41256-025-00409-x
Image Credits: AI Generated
