Place, Time and Experience: Barriers to Universalization Of Institutional Child Delivery in Rural Mozambique

Abstract

CONTEXT Although institutional coverage of childbirth is increasing in the developing world, a substantial minority of births in rural Mozambique still occur outside of health facilities. Identifying the remaining barriers to safe professional delivery services can aid in achieving universal coverage. METHODS Survey data collected in 2009 from 1,373 women in Gaza, Mozambique, were used in combination with spatial, meteorological and health facility data to examine patterns in place of delivery. Geographic information system–based visualization and mapping and exploratory spatial data analysis were used to outline the spatial distribution of home deliveries. Multilevel logistic regression models were constructed to identify associations between individual, spatial and other characteristics and whether women’s most recent delivery took place at home. RESULTS Spatial analysis revealed high- and low-prevalence clusters of home births. In multivariate analyses, women with a higher number of clinics within 10 kilometers of their home had a reduced likelihood of home delivery, but those living closer to urban centers had an increased likelihood. Giving birth during the rainy, high agricultural season was positively associated with home delivery, while household wealth was negatively associated with home birth. No associations were evident for measures of exposure to and experience with health institutions. CONCLUSIONS The results suggest the need for a comprehensive approach to expansion of professional delivery services. Such an approach should complement measures facilitating physical access to health institutions for residents of harder-to-reach areas with community-based interventions aimed at improving rural women’s living conditions and opportunities, while also taking into account seasonal and other variables.

Spatial clustering and determinants of home birth after at least one antenatal care visit in Ethiopia: Ethiopian demographic and health survey 2016 perspective

“…Mothers who had rich and middle income had 58, and 34% less chances of delivering at home after ANC visits respectively as compared to the poor. This finding is supported by those of other studies conducted in Ethiopia [11], rural Mozambique [10], Kenya [28] and Afghanistan mortality survey [29], where wealth index was independently associated with non-institutional delivery. Women who had primary, secondary and above secondary education were 55, 89 and 94% less likely to deliver at home respectively as compared to mothers who had no formal education.…”

“…A study conducted in Nigeria showed that most clustered cases of non-skilled attendant deliveries were found in upper east and upper west regions [9]. Home delivery had spatial variations in Mozambique, with low-value (9%) clusters in the east and high value (41%) clusters in middle west [10]. Most home deliveries occur in the developing countries of Africa and Asia, including Ethiopia [2,7].…”

Determinants of home delivery in Nepal – A disaggregated analysis of marginalised and non-marginalised women from the 2016 Nepal Demographic and Health Survey

“…Likewise, in this study, marginalised women located with their health facility at farther distance (>30 minutes) had higher odds of delivering at home, whereas it was not significant among non-marginalised women. Distance to health facility was also found to have significant effect for place of delivery in previous studies [32,34,35].…”

“…We could not find any previous studies comparing factors associated with home delivery disaggregated by ethnicity in Nepal. However, several studies demonstrated statistically significant associations of home delivery with mothers age at birth [31], educational level of the mother [32][33][34], wealth status [31,33], province [33], place of residence [31,33], travel time to nearest health facility [32,34,35], and completion of four ANC visits as per national protocol [31,32,34,36].…”

HIV status, fertility intentions, and contraception in the era of expanded access to antiretroviral therapy: A case study of rural Mozambique

“…All these facilities are part of the National Health Service (NHS) network and provide all MCH services, as well as HIV testing and ART, free of charge. The area has a relatively high coverage of institutional child deliveries—c.70% (Agadjanian, Yao, & Hayford, 2016); in addition, many of the women who happen to deliver outside a health clinic bring their newborns there for checkups and vaccinations early after the birth. The area has a very high coverage of antenatal care, with almost all pregnant women attending at least one antenatal consultation (Agadjanian, Yao, & Hayford, 2016).…”