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.
Highlights
Pakistan 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
According to the Pakistan Bureau of Statistics, every 20 min, a mother dies in Pakistan due to pregnancy-related complications because mothers still prefer to deliver at home
Women with a secondary education were more likely to deliver at a health facility (73%) than those who had no education (36%); women whose husbands were highly educated (57%) mostly preferred to deliver at a health facility, whereas those whose husbands were not educated did not (34%)
Summary
Pakistan 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. Most maternal deaths can be prevented when mothers deliver at a health facility instead of at home [5] because this decision decreases the likelihood of death for both the baby and the mother [6]. 536,000 women die every year due to pregnancy complications [7] because many women prefer to deliver at home without professional medical assistance in low-income settings [8]. Maternal and child mortality has decreased significantly in the last few decades in Pakistan, this measure has not reached the target set by Millennium Development Goal (MDG) five (75% reduction in maternal mortality by 2015). According to the Pakistan Bureau of Statistics, every 20 min, a mother dies in Pakistan due to pregnancy-related complications because mothers still prefer to deliver at home. 59 out of 1000 women die due to maternal causes in Pakistan [12]
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