Abstract
BackgroundPakistan has one of the highest rates of maternal and neonatal mortality in the world. It is assumed that employed mothers in paid work will be more empowered to opt for safer institutional deliveries. There is a need to understand the predictors of home deliveries in order to plan policies to encourage institutional deliveries in the region.MethodsThe study aimed to ascertain the predictors for home deliveries among mothers employed in paid work in Pakistan. Data analysis is based on secondary data taken from the Pakistan Demographic Health Survey 2012–13. Bivariate and multivariate logistic regression models were conducted.ResultsThe findings show that the majority (53.6%) of employed mothers in Pakistan give birth at home. Employed mothers in paid work with the following characteristics had higher chances for delivering at home: (i) women from rural areas (AOR 1.26; 95% CI: 0.94–1.71), or specific regions within Pakistan, (ii) those occupied in unskilled work (AOR 2.61; 95% CI: 1.76–3.88), (iii) women married to uneducated (AOR 1.70; 95% CI: 1.08–2.66), unemployed (AOR 1.69; 95% CI: 1.21–2.35), or unskilled men (AOR 2.02; 95% CI: 1.49–2.72), (iv) women with more than 7 children (AOR 1.57; 95% CI: 1.05–2.35), (v) women who are unable in the prenatal period to have an institutional check-up (AOR 4.84; 95% CI: 3.53–6.65), take assistance from a physician (AOR 3.98; 95% CI: 3.03–5.20), have a blood analysis (AOR 2.63; 95% CI: 1.95–3.57), urine analysis (AOR 2.48; 95% CI: 1.84–3.33) or taken iron tablets (AOR 2.64; 95% CI: 2.06–3.38), and (vi) are unable to make autonomous decisions with regard to spending their earnings (AOR 1.82; 95% CI: 1.27–2.59) and healthcare (AOR 1.12; 95% CI: 0.75–1.65).ConclusionsGreater efforts by the central and provincial state bodies are needed to encourage institutional deliveries and institutional access, quality and cost. Maternal and paternal benefits are needed for workers in both the formal and informal sectors of the economy. Finally, cultural change, through education, media and religious authorities, is necessary to support institutional deliveries and formal sector paid employment and out of home work opportunities for mothers of Pakistan.
Highlights
Pakistan has one of the highest rates of maternal and neonatal mortality in the world
The problem with community facilitators delivering in homes or at small and under-resourced health centers is that mothers are unable to seek prenatal check-ups and consultancy from specialised medical practitioners with complete institutional support
Seven independent variables were included in the analysis, which are based on a literature review: number of prenatal visits during pregnancy, prenatal assistance from physician, urine analysis taken during pregnancy, blood analysis taken during pregnancy, given/bought iron tablets during pregnancy, decision-maker for spending respondents’ money, and decision-maker for spending healthcare
Summary
Pakistan has one of the highest rates of maternal and neonatal mortality in the world. It is assumed that employed mothers in paid work will be more empowered to opt for safer institutional deliveries. Research from low-income regions shows that uneducated, unskilled and rural women working in the informal sector of the economy predominantly opt for home deliveries [8, 9]. Efforts by development bodies have targeted short term improvements to reduce maternal and child mortality by supporting women from rural and distant locations to give birth in their homes by skilled birth attendants or at local health centers with women attendants [12]. There is the dilemma that despite the availability of trained midwives, women from conservative communities still opt for traditional birth attendants for assistance in home deliveries [15]
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