The role of traditional birth attendants and neonatal mortality during armed conflict: A repeated cross-sectional analysis from Northern Nigeria

Armed conflict in Northern Nigeria has severely weakened health systems, reduced access to skilled birth attendants (SBAs) and increased reliance on traditional birth attendants (TBAs), especially in underserved communities. While TBAs fill critical service gap, concerns remain about their impact on neonatal outcomes. This study examines how conflict exposure influences the use of TBAs and assesses the relationship between TBA-assisted births and neonatal mortality in Northeast and Northwest Nigeria. We analyse data from the Nigeria Demographic and Health Surveys (2008-2018) linked with conflict data from the Armed Conflict Location and Event Dataset. We use logistic regression models to assess how conflict exposure affects TBA utilisation and neonatal mortality while controlling for demographic and socioeconomic variables. Conflict exposure significantly increases the use of TBA in Northeast Nigeria, though this reliance has declined over time. No consistent association was found between TBA-assisted births and neonatal mortality, suggesting that broader systemic factors influence newborn outcomes. In conflict-affected regions, TBA is sometimes a necessity due to systemic gaps in care delivery. Integrating the TBA into formal health systems through training and referral mechanisms is critical for improving care and achieving Sustainable Development Goal 3.2 to reduce neonatal deaths.