Factors associated with home delivery in rural Sindh, Pakistan: results from the global network birth registry

Abstract

Background According to global estimates for 2017, nearly 295,000 maternal deaths occurred worldwide. Thus, approximately 810 women die every day due to pregnancy-related complications. This burden of maternal deaths in LMICs is primarily due to poor healthcare service utilization, as indicated by relatively low rates of institutional deliveries and skilled-birth attendance (SBA). We conducted this study with an aim to assess the factors associated with home delivery and its subsequent effect on the pregnancy outcome in rural Sindh, Pakistan. Methods Data for this study were taken from The Global Network’s Maternal Newborn Health Registry (MNHR), which is a prospective, population-based observational cohort study. Registry data for 2018–2019 for District Thatta, Pakistan was retrieved for the analysis. Multivariable logistic regression models were used to determine the effect of each independent variable on the place of delivery by including all predictors and covariates. Results of the regression analyses are presented with crude odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Results A total of 4649 women were included in the study, of these, 1286 (27.7%) women had delivered at home. Of those who delivered at home, a larger proportion was illiterate (90%), had a BMI of less than 18.5 kg/m2 (26.0%), had parity of 3 or more (48.1%), and had a history of pregnancy loss as compared to women who had institutional delivery. In addition, two-thirds of women (63.4%) who had delivered at home had less than 4 ANC visits, whereas 15.6% did not receive any ANC. On multivariable logistic regression we found that home delivery was significantly associated with being illiterate (aOR = 1.60; [95% CI: 1.34, 2.04]), having high parity (aOR = 1.91; [95% CI: 1.58, 2.32]), and no ANC visit (aOR = 14.8; [95% CI: 10.2, 21.5]). Conclusions More than a quarter of our study sample women delivered at home. These women were illiterate, multiparous, and did not receive antenatal care during pregnancy. It is essential to conduct extensive educational interventions for the women and their family members regarding the potential benefits of delivering in a safe and skilled environment. Moreover, the provision of comprehensive and quality antenatal care should be ensured as it improves the mothers' health-seeking behavior and helps them make informed decisions about their health and well-being.

Women in low- and middle-income countries receive antenatal care at health institutions, yet not delivered there: a multilevel analysis of 2016–2021 DHS data

“…As expected, the IDD was higher among women who had inadequate ANC visits compared to those who had four and above visits in our study. A number of studies consistently reported that ANC utilisation was an important determinant of choice of place of delivery [ 12 , 14 , 20 , 38 , 39 ]. Often times, it is supposed that women at their contacts during ANC visits will obtain adequate information regarding their pregnancy status and possible complications, which they may encounter during childbirth and the possible management options available at the health facilities [ 40 , 41 ].…”

“…A number of studies consistently reported that ANC utilisation was an important determinant of choice of place of delivery [ 12 , 14 , 20 , 38 , 39 ]. Often times, it is supposed that women at their contacts during ANC visits will obtain adequate information regarding their pregnancy status and possible complications, which they may encounter during childbirth and the possible management options available at the health facilities [ 40 , 41 ]. Besides, women who have adequate ANC visits would have frequent contacts with the healthcare providers and they may develop trust and confidence to prefer delivery at the health facilities [ 42 ].…”

Pregnant Women’s Perceptions of the Quality of Antenatal Care in a Public Hospital in Punjab, Pakistan during COVID-19: A Cross-Sectional Study

“…Poor educational status, low income, more than four children, and long waiting times showed associations with the perceived poor quality of healthcare services. Women who had given birth to two or more children were less likely to give birth in a medical facility than women who were giving birth for the first time, thus showing their dissatisfaction with the services provided [ 8 ]. The influence of education is significant, as women who have completed secondary or higher education had three times the likelihood of giving birth in a medical facility.…”

“…Even before the onset of the pandemic, maternal and child health programs in the country faced challenges such as inadequate implementation of policies, administrative issues, human resource shortages, inconsistent supplies, and failure to provide high-quality maternal care [ 7 ]. Of expectant mothers, 50% in the rural areas of the country prefer deliveries at home by traditional birth attendants, because they believe that the quality of services offered at these public health facilities, the way they are treated by the healthcare providers, and the number and skills of staff at public facilities are not adequate [ 8 ]. This perceived poor quality results in delayed engagement or non-attendance during the antenatal period, poor birth preparedness, and complication readiness, and then leads to unwanted pregnancy outcomes [ 9 ].…”

Diagnostic Accuracy Of Placental Thickness Measured By Ultrasonography In The Detection Of Intrauterine Growth Restricted (IUGR) Babies Keeping Actual Birth Weight As Gold Standard

“…In India, the proportion of IUGR is 54%. The actual incidence of IUGR in our country remains unveiled due to a large number of home deliveries where there is no concept of weighing the baby at birth (8,9) . An early diagnosis of IUGR is essential and helpful in optimizing antenatal and perinatal feto-maternal care.…”