Where a birth takes place is one useful, though incomplete, measure of access to maternal and newborn care. UNICEF labels this indicator Institutional delivery and defines it as the percentage of adolescent girls and women aged 15–49 who gave birth in a health facility. A hospital or clinic birth does not by itself guarantee high-quality care, but it can increase the chance that a mother and newborn are connected to trained staff, equipment, referral systems, and emergency treatment when complications occur.
This comparison uses Table 3 of UNICEF’s State of the World’s Children 2025 Statistical Compendium. To keep the time window consistent, it retains only the latest observation within 2018–2024. That leaves 97 countries and areas. Values marked x by UNICEF are observations from outside the period shown in the column heading, so they are excluded from the map, ranking, mean, and median rather than being relabelled as recent data.
Table of Contents
The country median is 94%, but that is not the same as the global 79%
Across the 97 retained countries and areas, the unweighted median is 94% and the simple mean is 86.5%. Neither figure means that 94% of all births worldwide occur in health facilities. Each country receives equal weight in these calculations, so a small country affects the median and mean as one observation just as a very populous country does.
UNICEF reports an official world institutional-delivery aggregate of 79% in the same table. Its regional and global aggregates use population-weighted methods appropriate to the target population. The two numbers therefore answer different questions. The 94% median describes the middle country in this 97-country comparison, while the official 79% is more appropriate for understanding the population-weighted global level.
Somalia is lowest at 21%, followed by Chad at 27%
Among observations that fall inside the 2018–2024 window, Somalia is lowest at 21%. Chad follows at 27%, Madagascar at 39%, Nigeria at 43%, Niger at 45%, Yemen at 47%, and Ethiopia at 48%. These seven are below 50%. Guinea-Bissau is exactly 50%, while Guinea and Papua New Guinea are at 53% and 55% respectively.
| Country or area | Births in health facilities |
|---|---|
| Somalia | 21% |
| Chad | 27% |
| Madagascar | 39% |
| Nigeria | 43% |
| Niger | 45% |
| Yemen | 47% |
| Ethiopia | 48% |
| Guinea-Bissau | 50% |
| Guinea | 53% |
| Papua New Guinea | 55% |
| Central African Republic | 58% |
| Mozambique | 65% |
| Bangladesh | 65% |
| Afghanistan | 66% |
| Cameroon | 67% |
A low percentage should not be converted into a one-number score for the quality of an entire health system. Distance to facilities, transport, costs, conflict, disasters, rural infrastructure, local preferences, and the survey year can all influence where people give birth. This single indicator does not contain those explanatory variables, so the map can identify places with lower observed facility use but cannot prove why the level is low.
Most of the retained countries are at 90% or above
The upper end is crowded. Of the 97 retained observations, 59 are at least 90%, 48 are at least 95%, and 30 are at least 99%. Fourteen are shown as 100%: Argentina, Azerbaijan, Belarus, Bulgaria, China, Cuba, Fiji, Jamaica, Kyrgyzstan, Mongolia, Serbia, Singapore, Thailand, and Turkmenistan.
A published value of 100% should be read as 100 at the reported precision, not as a philosophical claim that no exceptional birth occurred outside a facility. Likewise, a difference between 99% and 100% is not a reliable basis for ranking health systems. Survey uncertainty, reporting practices, and different observation years inside the seven-year window make broad level differences more informative than tiny one-percentage-point gaps.
Regional aggregates show a large geographic gap
UNICEF’s summary rows in the same table report 97% for East Asia and the Pacific and 97% for Latin America and the Caribbean. South Asia is 82%, the Middle East and North Africa 85%, and Sub-Saharan Africa 65%. Eastern and Southern Africa is 68%, while West and Central Africa is 63%. The world aggregate is 79%.
Regional averages are useful for showing the broad pattern, but they can hide substantial variation within a region. Countries in Sub-Saharan Africa span a wide range, and South Asian countries also differ. For program design or access analysis, country-level values should ideally be supplemented with residence, wealth, subnational, and service-quality data rather than assuming that one regional average describes every population.
Institutional delivery is not the same as skilled birth attendance
Table 3 places Institutional delivery next to Skilled birth attendant, but the concepts are distinct. Institutional delivery asks about the place of birth. Skilled birth attendance asks whether the birth was attended by skilled health personnel, typically a doctor, nurse, or midwife. The indicators often move together, yet they are not interchangeable.
A birth outside a facility may still involve a skilled attendant, and a facility birth does not imply that every facility has the same staffing, equipment, emergency capacity, or quality of care. Maternal mortality, antenatal visits, C-section rates, postnatal checks, and emergency obstetric services are separate outcomes and require their own indicators. This map should therefore be read narrowly as a comparison of birth location.
The 2018–2024 label is a period, not one synchronized survey year
UNICEF marks this column with R, meaning the most recent year available during the period specified in the heading. Countries were not all measured in 2024. One observation may come from 2024 and another from an earlier year between 2018 and 2024. The map is therefore a latest-within-period comparison, not a pure single-year snapshot.
That matters when values are changing quickly. A country observed several years earlier may have improved or declined since its survey. Small ranking differences such as 65% versus 66% should not be treated as precise current standings. Larger bands—below 50%, roughly 50–75%, 75–90%, and 90% or above—are generally more useful for reading the geography of the data.
Why 74 older observations are excluded even though they have numbers
UNICEF uses the marker x when data refer to years or periods other than those specified in the column heading, and it states that such data are not included in regional and global averages. The institutional-delivery column contains many numeric values with this marker. Treating every visible number as if it came from 2018–2024 would make the public time label misleading.
There are 171 country or area rows with a numeric institutional-delivery value in the table, but 74 carry the out-of-period marker for this indicator. This analysis excludes those 74 and works with 97 period-consistent observations. The smaller sample is a deliberate trade-off: it sacrifices geographic completeness in order to avoid mixing much older data into a recent-period ranking.
Missing countries are not zero-percent countries
The 97 retained observations do not cover every country in the world. Some countries have no institutional-delivery value, while others only have a value outside the common 2018–2024 window. Missing observations are never converted to zero. No data and zero percent are different statistical statements, and confusing them would make the map look more complete while making it less accurate.
Some small island states and areas may also be difficult to see on a low-resolution world boundary layer even when a value exists. The table and source documentation remain important companions to the map. A geographic graphic is useful for pattern recognition, but it should not replace checking the indicator definition, period, and data-availability notes.
What this indicator can and cannot say about maternal care
A high institutional-delivery share indicates that a large proportion of births connect with a health facility. That is relevant to access, referral, and emergency-care planning. It does not directly measure whether the facility had enough staff, whether essential medicines were available, whether respectful care was provided, whether complications were managed correctly, or whether maternal and newborn outcomes were good.
A low share also does not, on its own, identify a policy failure or the attitudes of families. Geographic distance, affordability, transport, conflict, distribution of maternity facilities, and urban-rural inequality can all matter. Combining facility-birth coverage with skilled attendance, antenatal care, postnatal care, maternal mortality, travel-time, and health-financing indicators can provide a much more complete picture.
Source and calculation method
Country values come from UNICEF’s State of the World’s Children 2025 Statistical Compendium, Table 3: Maternal and Newborn Health. UNICEF defines institutional delivery as the percentage of adolescent girls and women aged 15–49 who gave birth in a health facility. The listed main sources are DHS, MICS, and other national household surveys, and the table reports an October 2025 update for this indicator.
The analysis retains only values that belong to the stated 2018–2024 period. The final comparison includes 97 observations, with an unweighted median of 94% and mean of 86.5%. Seventy-four numeric values marked x are excluded, as are missing values. UNICEF’s official world figure of 79% is a weighted aggregate and should not be substituted with the simple country mean. Additional background is available on UNICEF’s Delivery care page.
Frequently Asked Questions
What does institutional delivery mean?
UNICEF defines institutional delivery as the percentage of adolescent girls and women aged 15–49 who gave birth in a health facility.
Which country has the lowest share in the 2018–2024 comparison?
Among observations within the common period, Somalia is lowest at 21%, followed by Chad at 27%, Madagascar at 39%, and Nigeria at 43%.
Why does a 2025 UNICEF report use 2018–2024 data?
The report’s institutional-delivery column is defined as the most recent observation available within 2018–2024. The report year and each country’s actual observation year are not necessarily the same.
Why is the 97-country median 94% while UNICEF reports a world value of 79%?
The 94% figure is an unweighted median across the retained countries. UNICEF’s 79% world figure is a population-weighted aggregate, so the calculations answer different questions.
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