Women's choice of delivery site and the surge in private facility-based deliveries in Pakistan: A 28-year trend analysis

Abstract

ObjectiveThis paper aims at estimating the long-term trends of facility-based and home-based deliveries and identifies the factors associated with the choice of delivery site. Study designSecondary analysis evaluating the trends in the choice of the delivery site by women of reproductive age using Pakistan Demographic and Health Surveys from 1990–91 to 2017–18. Main outcome measuresThe main outcome measure of this study is the choice of delivery site. MethodThis study used data from four waves of Pakistan Demographic and Health Surveys (DHS) corresponding with 1990–91, 2006, 2012–13 and 2017–18. Logistic regression was used for empirical analysis. ResultsThe odds of home delivery significantly came down in 2017–18 relative to 1990–91 (OR = 0.09; 95% CI:0.08–0.12; P < 0.001), growth in the likelihood of institutional delivery shows wide disparities. While the odds of delivery at the public health facility nearly doubled from 1990 to 91 to 2017–18 (OR = 2.12; 95% CI:1.70–2.65; P < 0.001), the odds of delivery at the private health facilities in the same period increased nearly eight times (OR = 7.78; 95% CI:6.45–9.38; P < 0.001). ConclusionResults suggest an investment gap in public health facilities and an inequitable health care system in Pakistan.