Facility-based delivery and maternal and early neonatal mortality in sub-Saharan Africa: a regional review of the literature.

Regional variability in facility-based delivery (FBD) rates in sub-Saharan Africa (SSA) is not well understood, nor is the relationship between FBD and national maternal and early neonatal mortality rates. A systematic literature review identified studies documenting the factors associated with FBD, stratified by region. Rates of skilled birth attendance, facility delivery, maternal mortality, and early neonatal mortality were compared across nations and regions. 70 articles met inclusion criteria, reflecting wide variability in the number, type, and quality of studies by region. Within-country differences were most pronounced in nations where multiple studies were conducted. Correlation between FBD and maternal mortality rates throughout SSA was -0.69 (p=.008), and the correlation between facility delivery rates and early neonatal mortality rates was -0.41 (p=0.08). This study demonstrates the need to attend to regional differences both across and within SSA nations if facility delivery rates are to be improved to reduce maternal and early neonatal mortality.