Prevalence and determinants of the place of delivery among reproductive age women in sub–Saharan Africa

Abstract

Introduction Maternal mortality is an issue of global public health concern with over 300,000 women dying globally each year. In sub-Saharan Africa (SSA), these deaths mainly occur around childbirth and the first 24hours after delivery. The place of delivery is, therefore, important in reducing maternal deaths and accelerating progress towards attaining the 2030 sustainable development goals (SDGs) related to maternal health. In this study, we examined the prevalence and determinants of the place of delivery among reproductive age women in SSA. Materials and methods This was a cross-sectional study among women in their reproductive age using data from the most recent demographic and health surveys of 28 SSA countries. Frequency, percentage, chi-square, and logistic regression were used in analysing the data. All analyses were done using STATA. Results The overall prevalence of health facility delivery was 66%. This ranged from 23% in Chad to 94% in Gabon. More than half of the countries recorded a less than 70% prevalence of health facility delivery. The adjusted odds of health facility delivery were lowest in Chad. The probability of giving birth at a health facility also declined with increasing age but increased with the level of education and wealth status. Women from rural areas had a lower likelihood (AOR = 0.59, 95%CI = 0.57–0.61) of delivering at a health facility compared with urban women. Conclusions Our findings point to the inability of many SSA countries to meet the SDG targets concerning reductions in maternal mortality and improving the health of reproductive age women. The findings thus justify the need for peer learning among SSA countries for the adaption and integration into local contexts, of interventions that have proven to be successful in improving health facility delivery among reproductive age women.

Health facility delivery among women of reproductive age in Nigeria: Does age at first birth matter?

“…Also, women who were exposed to mass media were more likely to give birth at the health facilities than their counterparts who were not exposed to mass media. This shows that the mass media plays a significant role in positively influencing the better practice of women’s reproductive health behavior [ 29 , 59 ]. This aligns with a spatial analysis study conducted in Nigeria in 2014 [ 46 ] and a recent study conducted in Ethiopia [ 60 ].…”

“…Those who responded respondent’s home and other homes were classified as “home delivery,” while the remaining responses were grouped as “health facility delivery”. This classification was informed by previous studies [ 29 – 32 ].…”

“…A total of thirteen covariates were studied. The covariates were selected based on their significant association with health facility delivery [ 29 , 30 , 34 , 35 ] and their availability in the DHS dataset. The covariates include maternal age, place of residence, parity, level of education, wealth quintile, current working status, marital status, religion, visit to the health facility in the past 12 months, permission to get medical help, distance to the health facility, region, and exposure to media.…”

Decomposing the urban–rural inequalities in the utilisation of maternal health care services: evidence from 27 selected countries in Sub-Saharan Africa

“…Several factors contribute to women’s better health in urban settings. Women in urban regions have easier access to health facilities and maternal health intervention programs [ 21 – 23 ]. The makeup of the urban population in terms of wealth index, educational status, and other socioeconomic characteristics may also have a beneficial impact on the use of maternal health care services [ 24 – 26 ].…”

Inequalities in Delayed Initiation of Breastfeeding: Evidence from Health Surveys in 58 Low- and Middle-Income Countries (2012-2017)

“…Women from the poorest quintiles of countries with poor health infrastructure are more likely to experience childbirth at home without skilled health personnel [52,53], increasing their likelihood of experiencing delayed breastfeeding initiation. This reason could explain the pattern observed in Niger, Chad, Ethiopia and Nigeria, where the rates of home births are high [54,55], and skilled attendance at birth is less than 50% [56]. The pro-rich pattern of absolute inequality we detected in these countries helps explain this pattern.…”