Should I stay or should I go?: consistency and switching of delivery locations among new mothers in 39 Sub-Saharan African and South/Southeast Asian countries

Abstract

The objective of this article is to assess the extent and determinants of switching delivery location between women’s first and second deliveries. We used Demographic and Health Survey data from 39 low- and middle-income countries on delivery locations from >30 000 women who had their first two deliveries in the 5-year survey recall period. Each delivery was characterized as occurring at home or in a health facility, facilities were classified as public- or private-sector. The extent of switching was estimated for each country, region and overall. Multivariable logistic regression models assessed determinants of switching (home to facility or facility to home), using four dimensions (perceived/biological need, socioeconomic characteristics, utilization of care and availability of care). Overall, 49.0% of first and 44.5% of second deliveries occurred in health facilities. Among women who had their first delivery at home, 11.8% used a facility for their second (7.0% public-sector and 4.8% private-sector). Among women who had their first delivery in a facility, 21.6% switched to a home location for their second. The extent of switching varied by country; but the overall net effect was either non-existent (n = 20) or away from facilities (n = 17) in all but two countries—Cambodia and Burkina Faso. Four factors were associated with switching to a facility after a home delivery: higher education, urban residence, non-poor household status and multiple gestation. Majority of women consistently used the same delivery location for their first two deliveries. We found some evidence that where switching occurred, women were being lost from facility care during this important transition, and that all four included dimensions were important determinants of women’s pattern of delivery care use. The relative importance of these factors should be understood in each specific context to improve retention in and provision of quality intrapartum care for women and their newborns.

Effect of maternal age on facility-based delivery: analysis of first-order births in 34 countries of sub-Saharan Africa using demographic and health survey data

“…However, studies which adjust for parity mainly conclude that older age at motherhood is associated with increased odds of facility-based delivery. 10 16 Despite this, some reviews show inconsistent results, 7 no effect of age 11 or decreased use with age unless the woman was younger than 18. 5 Older motherhood is associated with wealth, education, marriage, wanted pregnancies, 7 multiple births, known health problems and complications of labour.…”

“…21 Additionally, the experience in the first birth may determine the future health-seeking behaviours of that mother. 10 …”

Women’s retention on the Continuum of Maternal Care Pathway in West Gojjam Zone, Ethiopia: Multilevel Analysis

“…The reviewed pieces of literature reported inconsistent findings on the correlation between age and maternal service utilization; some show no effect [44], or older age at motherhood is associated with increased odds of maternity service use [45]. Our finding revealed that younger age at motherhood (between 15-24 years) was associated with increased odds of utilizing four or more ANC visits and facility-based delivery than older age women.…”

Effect of a maternal and newborn health system quality improvement project on the use of facilities for childbirth: a cluster‐randomised study in rural Tanzania

“…While this was not a pre‐specified focus of the research, given the background of overall high facility utilisation, this group emerged as an important subpopulation that is at greater risk for home delivery and potentially poor outcomes. For example, a recent study in 39 LMIC found that among women who had their first delivery at home, fewer than 12% switched to a facility for the second delivery . In our study population, the effect of the QI intervention was much stronger among these women, suggesting that their choice to remain home in the past may have been due to lack of high‐quality facility options nearby.…”

“…It is noticeable that the intervention did not have an effect on women whose prior delivery was at a health facility. This finding would be unsurprising if the default for these women was to deliver in a health facility – in the same study discussed above, nearly 80% of women who previously delivered in a facility used a facility for their second delivery .…”