Decision-making for birth location among women in Pakistan: evidence from national survey

Abstract

BackgroundPakistan ranks 149th in the maternal mortality ratio (MMR) and has failed to keep pace with other countries in the region, except Afghanistan, with respect to health indicators. Home deliveries are linked to a higher risk of maternal death; therefore, discouraging home deliveries is imperative to improve maternal health. This study provides a holistic view and analyses factors affecting home birth decisions within the context of maternal socio-demographic characteristics in Pakistan.MethodsThe study exploits the latest data from the Pakistan Demographic and Health Survey (2012–2013), which includes a nationally representative sample of 13,558 women aged 15–49 years. However, the sample was reduced to 6977 women who had given birth in the 5 years preceding the survey. Statistical techniques, including bi-variate and multivariate logistic regression, were used to analyse the data. The dependent variable was dichotomous and coded as 0 for home deliveries and 1 for deliveries at a health facility. The dependent variable was constructed based on information regarding the most recent birth in the 5 years preceding the survey.ResultsThe study reveals that giving birth at home is highly prevalent among mothers in Pakistan (Baluchistan, 74%; Khyber-Pakhtunkhwa, 53%; Gilgit Baltistan, 46%; Punjab, 45% and Sindh, 34%) because of their difficulty obtaining permission to visit a health facility, financial barriers, the distance to health facilities and transportation. Substantial variation is observed when geo-demographic characteristics are considered. Higher home childbirth rates have been recorded in rural areas compared with those in urban areas (OR 1.32; p ≤ 0.000). The likelihood of home birth is highest (OR 2.67; p = 0.000) among women in Baluchistan province and lowest (OR 0.48; p = 0.000) among mothers in Punjab province. After controlling for all odds ratios and demographic characteristics, the parents’ education levels remain a significant factor (p = 0.000) that affects women’s decisions to deliver at home rather than at a health facility.ConclusionThe study findings provide a better understanding of why women prefer to give birth at home. These results can help policymakers to introduce appropriate interventions to increase the number of deliveries at health facilities. These findings are expected to reduce maternal and neonatal mortality in Pakistan.

Predictors of wealth-related inequality in institutional delivery: a decomposition analysis using Nepal Multiple Indicator Cluster Survey (MICS) 2019

“…This nding corroborates previous study that analyzed rst-order births in 34 countries of sub-Saharan Africa and found that older age at birth was associated with signi cantly higher odds of facility-based delivery (34). Finding from this study aligns well also with the study from Bangladesh (35). However, the non-signi cant association was obtained in analysis from Pakistan and Ethiopia (3,36).…”

“…The odds of institutional delivery was twice in women who have completed four or more ANC visits. Positive association between the antenatal visits and facility-based delivery was found in previous studies conducted in Kenya, Ethiopia, Nepal, Bangladesh, Pakistan (3,4,6,35,37). The counselling on birth preparedness received from health workers during the antenatal visits could be the reason.…”

Women's decision‐making autonomy and utilization of antenatal, natal and post‐natal healthcare services: Insights from Tajikistan's national surveys

“…In comparison, Ul Husnain et al reported that women autonomy increased likelihood of deliveries in healthcare facilities in Pakistan. 7 Evidence from Sharma et al also corroborated previous findings by suggesting that women empowerment increased likelihood of having four prenatal visits and deliveries in healthcare facilities in Bangladesh, India and Nepal. 15 Finally, Chol and colleagues found a positive relationship between decision making on household income spending and major household purchases made by the women solely or jointly with husbands and the propensity to have four prenatal visits and delivery by skilled birth attendants in 31 Sub-Saharan African countries.…”

“…1 It is also associated with the reduction of maternal and neonatal mortality and improvement in the nutritional status of women and children. [7][8][9][10][11][12] Moreover, women's autonomy is positively correlated with human immunodeficiency virus (HIV) testing and cervical cancer screening awareness. 13,14 Finally, there is also evidence that women's autonomy is linked to the use of reproductive services in several developing countries of South Asia and Sub-Saharan Africa.…”

Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan

“…However, they do not attend childbirths and prompt visitation of newborns in the first few days of life and at other critical times has remained challenging [ 3 , 4 ]. Each LHW is responsible for approximately 1,000 people within a catchment area of about 100–150 houses, and many births continue to occur at home, often without skilled attendance [ 5 ]. Therefore, there is a need to empower mothers and families to provide important preventive care and to recognize signs of newborn illness early.…”