5 million children under five are dying every year; nearly half of them die in the first 28 days of life primarily due to premature birth, birth complications, neonatal infections, and congenital anomalies. Having access to a skilled health provider like a doctor, midwife, or nurse (skilled birth attendance) can reduce complications around birth and mitigate preventable maternal and child deaths. There has been notable progress in the percentage of births attended by a skilled health personnel from 64% on average during 2001-2007 to 84% during 2015-2021. However, the advances have not been equal for all groups and the rates vary widely across countries. In recent years progress has also slowed. Estimates by Save the Children show nearly 1 in 5 mothers globally will give birth without skilled attendance this year. This puts the lives of 24 million mothers and newborns at risk, many of those from disadvantaged backgrounds.

The Child Atlas depicts global data on skilled birth attendance, showing us where mothers and newborns are more at risk from unsafe deliveries. The map highlights countries with low skilled birth attendance rates, most of those in Sub-Saharan Africa. The contrast is stark in 11 countries in the region where less than half of the women give birth with skilled attendance. Most of these are low-income economies with often poor healthcare systems.

A new feature in the Child Atlas lets us add a contextual layer, which gives some background on the risks, crises, and insecurities in the country, if any. This allows us to see at a glance if countries with low skilled birth attendance rates are also countries experiencing other vulnerabilities. We find that among the 11 countries where less than half of the women give birth with skilled attendance, 8 countries are also conflict-affected, 7 are also affected by hunger, and 4 are experiencing extremely high climate risks. Further analysis is supporting this initial finding: mothers in conflict-affected countries are 3 times more likely to give birth without skilled attendance compared to those in countries not affected by conflict.

Cross-country differences give us a good overview of how the indicator varies across countries. In addition, it is important to look at disaggregated data to understand the inequalities faced by different groups of women and children. The Child Atlas visualises disaggregation of global skilled birth attendance data by residence and wealth quintile as shown below. We observe a 17-percentage points difference in births by skilled attendants between urban and rural residences (93% vs 76%). This gap is even larger, 29-percentage points, among the richest and poorest households (96% vs 67%). The size of the inequalities is evident from the size of the triangles.

Read more on skilled birth attendance and Save the Children’s recommendations to governments and donors on improving it in our recent policy brief, Silent Emergency: Women Dying, to Give Life.