Opting for home birth in rural Bangladesh: An assessment of the current status and reasons

Abstract

Background: In Bangladesh, over half of women give birth at home, generally without the support of a skilled birth attendant. In this article, we examined the decisionmaking around birthplace and explored the reported reasons of preferring home birth over facility birth in a rural district of Bangladesh. Methods: A cross-sectional household survey with 1367 women was conducted in Brahmanbaria district. Choice of birthplace and actual place of birth were the main outcomes of interest. Associations between the outcomes of interest and background characteristics were analyzed through binary logistic regression. Effects of the covariates and confounders were adjusted through multiple logistic regression. Results: Sixty-four percent of women planned to give birth at home, and 62% gave birth at home. Planning to give birth at home was significantly associated with eventually giving birth at home (AOR [CI]: 4.93 [3.79-6.43]). Multiparous women and women from larger households were significantly more likely to give birth at home, whereas more educated and wealthier women and those attending antenatal care were significantly less likely to give birth at home. The main reported reasons for home birth were perceived lack of importance of facility birth, financial reasons, fear of cesarean section, and not being permitted by a husband of other family member to seek facility birth. Conclusions: Home is the preferred birthplace and main actual place of birth in rural Bangladesh. The maternal health program of Bangladesh should look critically at the preferences of women and reasons for those preferences for further promotion of skilled attendance at birth in rural settings.

Prevalence of home birth among 880,345 women in 67 low- and middle-income countries: A meta-analysis of Demographic and Health Surveys

“…In Sub-Saharan African countries, such as Tanzania, a high proportion of births are attended at home by non-qualified providers such as TBA, siblings, or neighbors, and it has been described that a lack of formal education, scarce telecommunication access, low acceptance to ANC services, low socioeconomic status, and geographic location were all related to the choice of home over institutional birth ( Moshi & Mbotwa, 2020 ). In Bangladesh (South Asia region), another country with a high proportion of home births, low family-perceived importance of institutional delivery, financial constraints, fear of cesarean section, and husbands not allowing delivery at health establishments were associated with having births at home ( Perkins et al, 2019 ). In general, LMICs present the highest proportions of home births and share the presence of factors that increase the probability of home birth care.…”

Determinants and Trends of Health Facility Delivery in Bangladesh: A Hierarchical Modeling Approach

“…In most studies, binary logistic regression models are most commonly used. Perkins et al [22] and Ahinkorah et al [23] attempted to uncover the determinants of the delivery of health facilities by using a binary logistic regression model but identified only individual factors. However, community factors also influence medical care.…”

Unpacking cesarean in rural Bangladesh: Who, what, when, and where

“…Currently, the Bangladesh Maternal Health Strategy does not acknowledge pain management as a critical issue in rendering birth services. 17 Although some studies demonstrated that fear of cesarean serves as a barrier to seeking birth in a health facility, 18,33 in this context, for some women, undergoing cesarean could have been the only means to access some form of pain management.…”