Contextual Influences on the Use of Health Facilities for Childbirth in Africa

Abstract

Studies of maternal health seeking behaviour have focused on individual and household level factors. This analysis examines community level influences on the decision to deliver a child in a health facility across six African countries.Demographic and Health Survey data are linked with contextual data, and multilevel models are fitted to identify the determinants of childbirth in a health facility in the six countries. There are strong community level influences on a woman's decision to deliver her child in a health facility. Several pathways of influence between the community and individual were identified. Community economic development, the climate of female autonomy, service provision and fertility preferences all exert an influence on a woman's decision to seek care during labour, although significant community variation remains unexplained.

Community Socioeconomic Context and Its Influence on Intermediary Determinants of Child Health: Evidence From Colombia

“…These results are consistent with findings elsewhere examining the use of maternal health facilities (Stephenson et al, 2006;Ahmed et al, 2010) and underline the importance of women's empowerment within the household, allowing them to have greater decision-making powers regarding both their own health and that of their children.…”

Utilization of institutional delivery services across successive births in India

“…Furthermore, in rural India, traditional pregnancy is considered to be a natural state of being. These beliefs, coupled with mis-conceptions and fears of medical institutions, have led women to continue to rely on home births in India (Stephenson, Baschieri, Clements et al, 2006). As a result, rural women may continue to under-utilize health care facilities relative to urban women despite the introduction of free maternal care schemes.…”

“…Based on previous literature (Babalola and Fatusi, 2009;Baru et al, 2010;Stephenson et al, 2006;Thind et al, 2008), this study included the following socioeconomic and demographic factors: region (central, north, east, northeast, west, or south), place of residence (rural or urban), religion of the head of the household (Hindu, Muslim, or others), caste of the head of the household (scheduled tribe, scheduled caste, or others), wealth index for the household (poorest, poor, middle, rich or richest), educational status of women and their partners (illiterate, literate but below primary school, primary school completed but below middle school, middle school completed but below high school, or high school or above), loss of a child (no child lost or at least one child lost), sex composition of children (no son and no daughter, number of sons greater than daughters, number of sons less than daughters, or equal sons and daughters), ever having pregnancy terminated (no or yes), child's age in months (0-23, 24-35, 36-47, or 48-59), and birth order (second order birth, first order, third order, or 3+ order). The first category of each of these independent variables is considered as the reference category in the multivariate analyses.…”

A Mixed-Methods Evaluation of a Community-Based Behavior Change Program to Improve Maternal Health Outcomes in the Upper West Region of Ghana

“…While the community-based health planning and services (CHPS) strategy introduced through the Ghana health service (GHS) provides a platform to deploy health services in rural areas, there are still a number of social norms, and cultural practices at the community level that influence maternal health-seeking behavior including beliefs that husbands are not responsible for supporting their pregnant wives to maintain their antenatal schedules by providing finance, transport, or company (Nyonator, 2005; Sumankuuro, Crockett, & Wang, 2017). Several studies have shown that community beliefs and attitudes influence a woman’s decision to seek care (Kruk, Rockers, Mbaruku, Paczkowski, & Galea, 2010; Stephenson, Baschieri, Clements, Hennink, & Madise, 2006). Previous research in Ghana has found that women who live in communities where more women perceive higher use of facility delivery are more likely to deliver in a facility (Speizer, Story, & Singh, 2014).…”