Determinants of health facility utilization during childbirth among 15 to 49-year-old women in Uganda: evidence from the Uganda demographic health survey 2016

BackgroundAlmost all maternal deaths and other related morbidities occur in low income countries. Childbirth supervised by a skilled provider in a health facility is a key intervention to prevent maternal and perinatal morbidity and mortality. Our study aimed to establish the determinants of health facility utilization during childbirth in Uganda. MethodsWe used Uganda Demographic and Health Survey (UDHS) 2016 data of 10,152 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants and we conducted multivariable logistic regression to establish the determinants of health facility utilization during childbirth. All our analyses were done using SPSS version 25. ResultsThe proportion of women who gave birth from a health facility was 76.6% (7,780/10,152: (95% CI: 75.8-77.5). Odds of health facility birth decreased with older age. Women aged 15-19 years were twice as likely to give birth from health facilities compared to women aged 40 to 49 years (AOR=2.25; 95% CI: 1.71- 2.96). Women residing in urban areas were more likely to give birth from a health facility compared to those in rural areas (AOR=1.48; 95% CI: 1.18- 1.86), as well as those who attended ANC (AOR=3.60; 95% CI: 2.47- 5.24). Women in the Northern region were more likely to use health facilities compared to those in the Central region (AOR=2.42; 95% CI: 1.81- 3.22). Odds of health facility birth increased with rise in wealth index and education level. Women with higher education (AOR=5.15; 95% CI: 2.79- 9.52) and those in the richest wealth index (AOR=5.14; 95% CI: 3.72- 7.10) were five times more likely to give birth from a health facility compared to those with no education and those in the poorest wealth index respectively. ConclusionHealth facility utilization during childbirth was high and positively associated with; decreasing age, increasing level of education and wealth index, urban residence, Northern region and ANC attendance. We recommended that interventions to promote health facility childbirths in Uganda should target the poor, less educated and older women especially those residing in rural areas.

Socio-cultural Beliefs and Practices Influencing Institutional Delivery Service Utilization in Three Communities of Ethiopia: A Qualitative Study

BACKGROUND: The influence of socio-cultural factors on institutional birth is not sufficiently documented in Ethiopia. Thus, this study explores socio-cultural beliefs and practices during childbirth and its influences on the utilization of institutional delivery services.METHODS: A qualitative study was conducted in three regions of Ethiopia through eight focus group discussions (with women) and thirty in-depth interviews with key informants which included health workers, community volunteers, and leaders. The data were analyzed thematically.RESULTS: The study identified six overarching socio-cultural factors influencing institutional birth in the study communities. The high preference for traditional birth attendants (TBAs) and home as it is intergenerational culture and suitable for privacy are among the factors. Correspondingly, culturally unacceptable birth practices at health facilities (such as birth position, physical assessment, delivery coach) and inconvenience of health facility setting to practice traditional birth rituals such as newborn welcoming ceremony made women avoid health facility birth. On the other hand, misperceptions and worries on medical interventions such as episiotomy, combined with mistreatment from health workers, and lack of parent engagement in delivery process discouraged women from seeking institutional birth. The provision of delivery service by male health workers was cited as a social taboo and against communities' belief system which prohibited women from giving birth at a health facility.CONCLUSIONS: Multiple socio-cultural factors and perceptions were generally affected utilization of institutional birth in study communities. Hence, culturally competent interventions through education, re-orientation, and adaptation of beneficial norms combined with women friendly care are essential to promote health facility birth.