The Countdown to 2030 MNH Study Collaboration. Transitions in childbirth care provision: Understanding the rapid rise in institutional delivery in 21 countries of sub-Saharan Africa and the implications for future strategies

Abstract

This study evaluates the rapid increase in institutional deliveries across 21 Sub-Saharan African countries to analyze structural shifts in maternal and childbirth care provision. Utilizing cross-country comparative data from the Countdown to 2030 Collaboration, the authors examine national trends in facility-based births, highlighting how health system expansions and policy interventions have driven significant gains in maternal health coverage. However, the analysis demonstrates that rapid volume growth in facility care does not automatically translate into improved health outcomes, as persistent service quality gaps, infrastructure bottlenecks, and regional inequities continue to limit impact. The paper outlines strategic implications for future maternal and newborn health initiatives, emphasizing the critical need to transition from focusing solely on increasing facility access to prioritizing quality of care, emergency obstetric readiness, and equitable healthcare resource distribution.