Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study

Abstract

Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. Countries in Mesoamerica have emphasized in-facility delivery care by professionally skilled attendants, but access to good-quality delivery care is still lacking for many women. We examined the characteristics of women who had a delivery in a health facility and determinants of the decision to bypass a closer facility and travel to a distant one. We used baseline information from the Salud Mesoamerica Initiative (SMI). Data were collected from a large household and facilities sample in the poorest quintile of the population in Guatemala, Honduras and Nicaragua. The analysis included 1592 deliveries. After controlling for characteristics of women and health facilities, being primiparous (RR ¼ 1.15, 95% CI 1.10, 1.21), being literate (RR ¼ 1.24, 95% CI 1.04, 1.48), having antenatal care (RR ¼ 1.68, 95% CI 1.24, 2.27), being informed of the need for having a C-section (RR ¼ 1.07, 95% CI 1.02, 1.11) and travel time to the closest facility totaling 1-2 h vs under 30 min (RR ¼ 0.88, 95% CI 0.77, 0.99) were associated with in-health facility deliveries. In Guatemala, increased availability of medications and equipment at a distant facility was strongly associated with bypassing the closest facility in favor of a distant one for delivery (RR ¼ 2.10, 95% CI 1.08, 4.07). Our study showed a strong correlation between well-equipped facilities and delivery attendance in poor areas of Mesoamerica. Indeed, women were more likely to travel to more distant facilities if the facilities were of higher level, which scored higher on our capacity score. Our findings call for improving the capacity of health facilities, quality of care and addressing cultural and accessibility barriers to increase institutional delivery among the poor population in Mesoamerica.

Advantages and Disadvantages of Institutional Delivery and Home Delivery: A Qualitative Study in Northern Nigeria

“…This result might indicate the low quality of care at the health clinics, which should be improved. Our findings are mostly consistent with findings from previous studies [8][9][10][11][12][13][14][15].…”

Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria

“…To corroborate these findings, one previous study reported poor quality of services as detrimental to health facility deliveries, particularly in the realm of ‘process’ i.e. standards of care employed in the provision of these services [ 37 , 38 ]. However, in the current study we were limited by the data availability and accordingly not in a position to comment on which indicators of quality were compromised.…”

Exploring providers’ perceived barriers to utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria: A qualitative study

“…Similarly, a study among Mesoamerican women revealed that there was a relationship between well-equipped health facilities and use of such facilities for delivery services. Thus, it was observed that women make long journeys to those facilities that were considered equipped [ 25 ]. This makes it imperative that good attention should be given to primary health centers and rural areas if the maternal death burden in Nigeria should be improved.…”