Institutional Delivery and Satisfaction among Indigenous and Poor Women in Guatemala, Mexico, and Panama

Abstract

Indigenous women in Mesoamerica experience disproportionately high maternal mortality rates and are less likely to have institutional deliveries. Identifying correlates of institutional delivery, and satisfaction with institutional deliveries, may help improve facility utilization and health outcomes in this population. We used baseline surveys from the Salud Mesoamérica Initiative to analyze data from 10,895 indigenous and non-indigenous women in Guatemala and Mexico (Chiapas State) and indigenous women in Panama. We created multivariable Poisson regression models for indigenous (Guatemala, Mexico, Panama) and non-indigenous (Guatemala, Mexico) women to identify correlates of institutional delivery and satisfaction. Compared to their non-indigenous peers, indigenous women were substantially less likely to have an institutional delivery (15.2% vs. 41.5% in Guatemala (P<0.001), 29.1% vs. 73.9% in Mexico (P<0.001), and 70.3% among indigenous Panamanian women). Indigenous women who had at least one antenatal care visit were more than 90% more likely to have an institutional delivery (adjusted risk ratio (aRR) = 1.94, 95% confidence interval (CI): 1.44–2.61), compared to those who had no visits. Indigenous women who were advised to give birth in a health facility (aRR = 1.46, 95% CI: 1.18–1.81), primiparous (aRR = 1.44, 95% CI: 1.24–1.68), informed that she should have a Caesarean section (aRR = 1.41, 95% CI: 1.21–1.63), and had a secondary or higher level of education (aRR = 1.36, 95% CI: 1.04–1.79) also had substantially higher likelihoods of institutional delivery. Satisfaction among indigenous women was associated with being able to be accompanied by a community health worker (aRR = 1.15, 95% CI: 1.05–1.26) and facility staff speaking an indigenous language (aRR = 1.10, 95% CI: 1.02–1.19). Additional effort should be exerted to increase utilization of birthing facilities by indigenous and poor women in the region. Improving access to antenatal care and opportunities for higher-level education may increase institutional delivery rates, and providing culturally adapted services may improve satisfaction.

Women’s satisfaction and its’ associated factors on institutional delivery services provided by public health facilities of Tanahun district, Nepal

“…A study conducted in public health facilities of Kenya states that more than half (51.7%) were multiparous where as in this study 35% were multiparous. A tri-nation study states that decision regarding utilization of birthing facilities is often made by the husband or his family members rather than by the parturient woman [13] where as another study of eastern Nepal showed that slightly more than half of the of decision for delivery point were made by mother and her spouse which is also considered as supporting details to this study. [33] The reason behind this could be because of the patriarchal nature of society, where the nal decision are mostly made by the husbands or elder persons of the household regarding delivery point.…”

“…They are delay in seeking care, delay in reaching care and delay in receiving care. Poor birth preparedness, knowledge on institution delivery, family in uence on decision, geographical inaccessibility, and unmet needs of care in CEONC and fear of hospital setting [13] are common factors related to rst delay. Late and poor-quality referral, transport not available and inadequate decisions by husband/relatives have been associated with the second type of delay.…”

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

“…Delivery care is cost-free in government-managed facilities. Midwifery is legal, with a substantial proportion of deliveries attended by midwives in poor areas of Guatemala (Colombara et al 2016). …”

Institutional Delivery Service Utilization And Associated Factors In Ethiopia: A Systematic Review And Meta Analysis

“…Women who have sufficient knowledge about delivery danger signs might have perceived service benefits of a health institution, like complication management by skilled health care workers in time of labor. Haiti service provision assessment survey who attend primary in rural Haiti(AOR=1.47),who attend secondary and above in rural Haiti(AOR=2.06)[47], who attend secondary & above in Guatemala,Mexco and panama(AOR=1.36)[52], an analysis from Bangladesh Demographic Health Survey 2011 who attend Primary school(AOR=1.264), Secondary & .783) than mothers with inadequate exposure. This finding was supported by a primary cross sectional study in a remote mountains district of Nepal[56].…”