Abstract
BackgroundHealth professionals and public health experts in maternal and newborn health encourage women to deliver at health facilities in an effort to reduce maternal and newborn mortality. In the existing literature, there is scant information on how migration, family members and community influence facility delivery. This study addresses this knowledge gap using 10 years of longitudinal surveillance data from a rural district of Tanzania.MethodsMultilevel logistic regression was used to quantify the influence of hypothesized migration, family and community-level factors on facility delivery while adjusting for known confounders identified in the literature. We report adjusted odds ratios (AOR).ResultsOverall, there has been an increase of 14% in facility delivery over the ten years, from 63% in 2001 to 77% in 2010 (p < .001). Women residing in households with female migrants from outside their community were more likely to give birth in a facility AOR = 1.2 (95% CI 1.11-1.29). Furthermore, the previous facility delivery of sisters and sisters-in-law has a significant influence on women’s facility delivery; AOR = 1.29, 95% CI 1.15-1.45 and AOR = 1.7, 95% CI 1.35-2.13 respectively. Community level characteristics play a role as well; women in communities with higher socioeconomic status and older women of reproductive age had increased odds of facility delivery; AOR = 2.37, 95% CI 1.88-2.98 and AOR = 1.17, 95% CI 1.03-1.32 respectively.ConclusionAlthough there has been an increase in facility delivery over the last decade in Rufiji, this study underscores the importance of female migrants, family members and community in influencing women’s place of delivery. The findings of this study suggest that future interventions designed to increase facility delivery must integrate person-to-person facility delivery promotion, especially through women of the community and within families. Furthermore, the results suggest that investment in formal education of the community and increased community socio-economic status may increase facility delivery.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-329) contains supplementary material, which is available to authorized users.
Highlights
Health professionals and public health experts in maternal and newborn health encourage women to deliver at health facilities in an effort to reduce maternal and newborn mortality
We hypothesize that the maternal healthcare experience of individuals in a woman’s family is likely to influence her decision of place of delivery. In addition to these two new variables, we examine the influence of three community level factors: 1) average educational attainment for women in the community, 2) average household wealth in the community derived from an asset index, and 3) average age of women of reproductive age in the community
With respect to average community wealth, in Model 3 we find that, women in communities with higher socio-economic status have increased odds of facility delivery (AOR = 1.93, 95% 95% confidence interval (CI): 1.45 – 2.57)
Summary
Health professionals and public health experts in maternal and newborn health encourage women to deliver at health facilities in an effort to reduce maternal and newborn mortality. There is scant information on how migration, family members and community influence facility delivery. This study addresses this knowledge gap using 10 years of longitudinal surveillance data from a rural district of Tanzania. Women’s attitudes towards use and availability of medical services influence their likelihood of delivering in a facility, including subscription to community health insurance, attitudes toward medical doctors, acceptability of traditional birth attendants, attitudes toward facility health delivery and frequency of antenatal care (ANC) visits [4,6,8,9,10,11]. Lack of understanding about the importance of facility delivery and women’s lack of household decision making power have been reported as barriers to facility delivery in other studies [3,8,11]
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