Factors associated with non-utilisation of health service for childbirth in Timor-Leste: evidence from the 2009-2010 Demographic and Health Survey

Abstract

BackgroundTimor-Leste is a young developing country in Asia. Most of its infrastructure was destroyed after a long armed conflict for independence. Despite recent expansion of health facilities and investment in healthcare, maternal mortality remains high with most mothers still giving birth at home. This study investigated factors affecting the non-utilisation of health service for childbirth in the aftermath of the independence conflict.MethodsThe Timor-Leste Demographic and Health Survey 2009-2010 was the latest two-stage national survey, which used validated questionnaires to obtain information from 26 clusters derived from 13 districts of the country. Factors influencing non-utilisation of health facility for childbirth were investigated using univariate and multivariable logistic regression analyses, accounting for the cluster sampling and sample weight of the survey.ResultsOf the total 5986 participants included in the study, 4472 (74.8%) did not deliver their last child at a health facility. Lack of education for the mother (adjusted odds ratio (OR): 2.04; 95% confidence interval (CI) 1.56 to 2.66) and her partner (OR: 1.45; 95% CI 1.14 to 1.84), low household wealth status (OR: 5.20; 95% CI 3.93 to 6.90), and rural residence (OR: 2.83; 95% CI 2.22 to 3.66), were associated with increased likelihood of non-utilisation of health facility for childbirth. Working mothers (OR: 1.55; 95% CI 1.32 to 1.81), who had high parity (OR: 1.78; 95% CI 1.36 to 2.32) and did not attend antenatal care service (OR: 4.68; 95% CI 2.65 to 8.28) were also vulnerable for not delivering at a health facility. Conversely, the prevalence of non-utilisation of health facility for childbirth reduced with increasing number of service components received during antenatal care visits (OR: 0.72; 95% CI 0.64 to 0.80).ConclusionsOnly a quarter of Timorese women delivered at a health facility. In order to reduce maternal mortality, future interventions should target disadvantaged mothers from poor families, those residing in rural areas, have higher parity but no education, and who seldom attend antenatal care service, by improving their utilisation of health facility for childbirth.

Prevalence and factors associated with non-utilization of healthcare facility for childbirth in rural and urban Nigeria: Analysis of a national population-based survey

“…This finding agrees with previous evidence showing that mothers who attend antenatal services would more likely patronize facility-based delivery [5,24]. Similarly, low educational attainment (both maternal and paternal) and poor wealth index were associated with higher chances of home delivery in all residences but the strength of associations was stronger in urban residence These two factors (lack of education and poor wealth index) are perhaps the most frequently cited for increased probability of home delivery in the literature [5,24].Even where access to institutional delivery was freely available in rural Tanzania, home delivery was substantially more likely among the poor and uneducated mothers [24]. The poor and the uneducated often lack economic empowerment, necessary health awareness, confidence and cognitive skills for informed 12 decision-making, thus, they are less likely to patronize institutional delivery [5,25].…”

“…Irrespective of rural-urban residence, birth order of one was associated with a decreased likelihood of home delivery. This result is consistent with findings in studies [5,24]. A likely explanation would be the impact of unpleasant delivery experiences in women with higher parity and/or the belief that childbirth is a natural process following past deliveries that were complication-free [5,16].…”

“…Multivariable logistic regression analyses were conducted to examine the adjusted association between the outcome variable and the independent variables using the hierarchical modelling method [5,19].…”

“…Based on current evidence, Nigeria, followed by India, had the highest number of maternal deaths in 2015 -approximately 58 000 and 45 000 deaths, respectively [4]. Sadly, the majority of these mortalities were uncalled for as they are generally preventable by utilizing healthcare facilities for childbirth (institutional or facility-based delivery) [5]. The rationale for this premise is well-established.…”

“…Independent variables were selected based on the objective of this study and the review of previous studies [5,10,11]. The variables were broadly categorized into three -individual-, household -and community-level variables [5].…”