Published in PLOS One on 2026-01-06, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Hiwot Tezera Endale, Tseganesh Asefa, Tiget Ayelgn Mengstie, Mihret Getnet, Helen Lamesgin Endalew, Amare Belete Getahun, Gashaw Dessie, Thomas Kidanemariam Yewodiaw, Engidaw Fentahun Enyew, Sabita Tuladhar
Source: PLOS One • DOI 10.1371/journal.pone.0340011
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Skilled birth attendant (SBA) delivery, defined as childbirth assisted by trained healthcare professionals such as doctors, midwives, and nurses, is a cornerstone of the World Health Organization’s Safe Motherhood Initiative to reduce maternal mortality. Despite high SBA coverage in Lesotho, maternal mortality remains elevated. This study aimed to assess the determinants of SBA delivery among reproductive-age women in Lesotho using the 2023–2024 Lesotho Demographic and Health Survey data.
A cross-sectional study design was applied using nationally representative data of 1,407 women aged 15–49 years. Multilevel logistic regression models were employed. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were reported, with p-values <0.05 considered statistically significant.
Skilled birth attendant (SBA) coverage was 91.8%. Women aged 35–49 had 60% lower odds of SBA delivery (AOR = 0.40; 95% CI: 0.17, 0.95). Higher maternal education (primary: AOR = 1.47; 95% CI: 1.02, 4.90; secondary: AOR = 1.63; 95% CI: 1.12, 2.94; and tertiary: AOR = 3.88; 95% CI: 2.50, 5.20), wealthier households (AOR = 4.30; 95% CI: 1.10, 16.80), and age at first birth between 20–24 years (AOR = 3.74; 95% CI: 1.77, 7.89) were positively associated with SBA delivery. Women initiating ANC in the third trimester had 63% lower odds of SBA use (AOR = 0.37; 95% CI: 0.14, 0.99).
Despite high SBA coverage in Lesotho, disparities exist, particularly among older women and late ANC initiators. Targeted policies such as community-based health education programs, transport support for rural women, mobile health reminders, incentives for facility deliveries, and the deployment of skilled birth attendants in underserved areas are vital to improving access, promoting education, encouraging early ANC engagement, and ultimately enhancing SBA utilization to reduce maternal mortality.
Introduction
Sustainable Development Goal (SDG) 3, target 3.1, aims to reduce the global maternal mortality ratio to fewer than 70 deaths per 100,000 live births by 2030 [1]. Achieving this goal depends significantly on skilled birth attendant (SBA) delivery [2,3]. SBA delivery, defined as childbirth assisted by a trained healthcare professional such as doctors, midwives, and nurses, is one of the World Health Organization’s (WHO) four key pillars of the Safe Motherhood Initiative aimed at reducing maternal mortality [4–7]. By providing a safe and supportive environment during delivery, SBA helps minimize complications for both mothers and newborns. Globally, about two-thirds of births are attended by skilled health personnel [8,9].
Between 2000 and 2023, the global maternal mortality ratio (MMR, maternal deaths per 100,000 live births) declined by about 40%, yet over 90% of maternal deaths occurred in low- and lower-middle-income countries in 2023. Although maternal mortality decreased from 385 in 1990–216 in 2015, and further to 197 per 100,000 live births in 2023, Sub-Saharan Africa alone accounted for approximately 70% of maternal deaths (182,000) [10–13]. In Lesotho, while 87% of births are attended by skilled health personnel, the maternal mortality ratio (MMR) remained high at approximately 566.2 deaths per 100,000 live births in 2020 [14]. According to the World Health Organization (WHO), Lesotho’s MMR decreased by nearly 10%, from 566.2 to 478 deaths per 100,000 live births between 2020 and 2023, with an estimated 267 maternal deaths in 2023. Despite this progress, the MMR remains above the Sub-Saharan African average of 442 per 100,000 live births, highlighting the need for continued efforts to achieve the global target of fewer than 70 maternal deaths per 100,000 live births by 2030 [15]. Several national efforts, including the implementation of community-based maternal health programs and initiatives to improve antenatal care coverage, have been launched to improve maternal health outcomes in Lesotho. However, geographical barriers, limited healthcare infrastructure in rural areas, and socioeconomic disparities continue to hinder equitable access to skilled delivery services [14].
Reading this evidence
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© 2026 Hiwot Tezera Endale, Tseganesh Asefa, Tiget Ayelgn Mengstie, Mihret Getnet, Helen Lamesgin Endalew, Amare Belete Getahun, Gashaw Dessie, Thomas Kidanemariam Yewodiaw, Engidaw Fentahun Enyew, Sabita Tuladhar. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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