Determinants of Institutional Delivery Among Women of Childbearing Age in Rural Haiti

Abstract

Institutional delivery is an important factor associated with reduced maternal mortality rate (MMR). MMR in Haiti is high (350 per 100,000) and institutional delivery is low-just over 25 % of women delivered at a health facility in 2010. There also exists substantial rural-urban disparity in delivery with more hospital deliveries in urban than in rural areas. We aimed to study the prevalence and determinants of institutional delivery in a sample of women of childbearing age in rural Haiti. The study took place in Fond des Blancs and Villa, as part of a baseline assessment undertaken prior to implementation of a maternal, child health, nutrition, and water and sanitation program. From October to November 2011, women 15-49 years old (N = 575) were selected using a cross-sectional two-stage sampling strategy. We used descriptive and multivariate logistic regression analyses to assess the prevalence of and factors associated with institutional delivery. The prevalence of institutional delivery was 45.4 %; a rate higher than the national average of 25 %. In adjusted analyses, correlates of institutional delivery were younger maternal age (25 years and younger) (OR 1.82; CI 1.15, 2.90; P = 0.0112), antenatal care receipt (OR 3.70; CI 1.84, 7.43; P = 0.0003) and those who were poor according to our poverty index score classification (OR 2.04; CI 1.13, 3.69; P = 0.0187). This study shows that increased hospital delivery is likely explained by accessibility to antenatal care. Programs that improve access to antenatal care, with concurrent efforts to address structural inequalities that drive socio-economic deprivation, are likely critical to increasing institutional delivery.

Limited Service Availability, Readiness, and Use of Facility-Based Delivery Care in Haiti: A Study Linking Health Facility Data and Population Data

“…A few studies have looked at social contextual factors such as community norms, media access, and the level of local development 12 – 15 . In Haiti, a few studies have found that facility delivery was associated with maternal and birth characteristics, household poverty, use of antenatal care services, and community exposure to mass media 16 , 17 …”

Childhood anemia in Rural Haiti: the potential role of community health workers

“…We analyzed data from a cross-sectional household based survey conducted from October to November 2011 in a predominantly rural region of about 65,000 inhabitants situated in the southern region of Haiti. The survey design and procedures have been described previously [ 23 , 24 ]. Briefly, a total of 800 households were selected for the survey using a two-stage sampling methodology.…”

Perceived Barriers to Contraceptive Use: An Exploratory Study of Women Living in Rural Haiti

“…In 2010, institutional deliveries were just over 25% of all Haitian births. A cross-sectional study conducted by Seraphin et al (2015) at Fond des Blancs and Villa, a rural and isolated region of about 65,000 inhabitants, aimed to identify factors contributing to women's access to medical care during obstetrical emergencies. Study participants were women of childbearing age (15-49) who gave birth in the five years preceding the survey (N = 575), (Seraphin.…”

“…In order to implement interventions to decrease MMR in low and middle-income countries, factors of preventive delivery care seeking behaviors need to be understood. Seraphin et al, (2015) state that in low income countries like Haiti, antenatal care provided by nongovernmental organization (NGO) offers an educational opportunity to motivate women to choose institutional delivery and thereby reduce maternal and infant mortality:…”

“…Older women tended to deliver at home, as compared to younger women. Seraphin et al (2015) reported, "While over 90% of the women received antenatal care, a little over 54% of the women reported to have delivered at home, a trend…”