Childbirth Location Research Articles

Promoting childbirth in a rural health facility: A quasi-experimental study in western Kenya.

The high maternal and neonatal mortality rate in sub-Saharan Africa could be reduced by using navigation by means of mobile devices to increase the number of women who choose to give birth in a health center (HC) with a skilled healthcare practitioner. A quasi-experimental design was used to test a midwife-delivered navigation by means of mobile phone. A total of 208 women were randomized to two groups (intervention and control). Women in the intervention group received up to three navigation calls from midwives. Women in the control group received usual antenatal education during prenatal visits. Data were collected using semistructured questionnaires. Childbirth location was determined through medical records. Overall, 180 (87%) women gave birth in a HC with a 3% advantage for the intervention group. A total of 86% (88/102) of the control group gave birth in a HC versus 89% (92/103) for the intervention group (Χ2 = 0.44, p-value = 0.51), with an unadjusted odds ratio of 1.33 (95% CI: 0.57, 3.09). Among those with personal phones, 91% (138/152) had a birth in a HC versus 79% (42/53) in those without a personal phone (Χ2 = 4.89, p-value = 0.03). The results of this study indicate that it is feasible to deliver phone-based navigation to support birth in a HC; personal phone ownership may be a factor in the success of this strategy.

Comparing the Characteristics of Neonates with FalsePositive Congenital Hypothyroidism Screening Results with Affected Neonates

Background: Congenital hypothyroidism is one of the most common preventable causes of mental retardation. The present study aimed to compare the characteristics of neonates with false-positive congenital hypothyroidism screening test results with affected neonates in Kerman. Methods: This cross-sectional study was conducted on neonates called to confirm congenital hypothyroidism from 2016 to 2017. The neonate characteristics (year and season of birth, sex, umbilical hernia, fontanelle conditions, constipation, jaundice, abnormalities, head circumference, height and weight at birth, gestational age, type of delivery, parental consanguinity, history of thyroid disease in the family, childbirth location, history of hospitalization, and place of residence) and maternal characteristics (age, number of deliveries, history of stillbirth, history of illness, and drug use during pregnancy) were extracted from their medical records. The collected data were analyzed with SPSS software (version 20) using the chi-square and independent samples t test. Results: From a total of 985 neonates who had a positive screening test, congenital hypothyroidism was confirmed in only 58 neonates(5.9%), and the other 927 neonates(94.1%) only had a positive screening test. The neonates’ and mothers’ characteristics were not significantly different in the two groups, except for constipation, which had a higher frequency in the neonates with a positive congenital hypothyroidism screening results than in the affected neonates (P=0.004). Conclusion: In this study, the characteristics of neonates who only had a positive hypothyroidism screening test result were not significantly different from those of the affected neonates. It is recommended that further studies be conducted over a longer period.

Knowledge of HIV and other sexually transmitted infections and place of delivery among urban women in South-West Nigeria

Background: HIV and other Sexually Transmitted Infections (STIs) pose serious risks to health security especially to women, therefore, knowledge of their complications and attitude toward sexual health is important in planning preventive and treatment strategies among women in Nigeria. This study aims to assess the knowledge of HIV and other STIs and its association with the choice of place of delivery among urban women in south west Nigeria. Methods: Data for urban women in south-west Nigeria was collected from National Demographic Survey (DHS) 2018. It evaluated their knowledge of HIV and other STIs in relation to the location of most recent childbirth. Chi-square (χ2) test and binary logistic regression analysis were conducted to establish association between variables using SPSS. Results: 4604 women were surveyed. Some (21.9%) of the respondents had poor knowledge of HIV and other STIs. Women who had secondary school education were 1.7 times and 2.6 times more likely to have knowledge of HIV and other STIs respectively (OR=1.737; p<0.001; CI=1.402 - 2.153; OR=2.604; p<0.001; CI=1.934 - 3.507). Women who delivered their first child in public healthcare facilities were 1.7 times more likely to have good knowledge of HIV and STIs (OR=1.674; p<0.001; CI=1.233 - 2.275). Conclusion: Women education and choice of place of delivery are important factors for knowledge of HIV and other STIs among urban women. Therefore, it is essential to implement more educational programmes specifically targeted at less educated women in urban regions of Nigeria.

Trends in facility-based childbirth and barriers to care at a birth center and community hospital in rural Chiapas, Mexico: A mixed-methods study

ObjectiveTo assess trends in childbirth at a hospital-birth center among women living in Compañeros En Salud (CES)-affiliated communities in Chiapas, Mexico and explore barriers to childbirth care. Our hypothesis was that despite interventions to support and incentivize childbirth at the hospital-birth center, the proportion of births at the hospital-birth center among women from Compañeros En Salud-affiliated communities has not significantly changed after two years. We suspected that this may be due to structural factors impacting access to care and/or perceptions of care impacting desire to deliver at the birth center. DesignThis explanatory mixed-methods study included a retrospective Compañeros En Salud maternal health census review followed by quantitative surveys and semi-structured qualitative interviews. Participants and SettingParticipants were women living in municipalities in the mountainous Sierra Madre region of Chiapas, Mexico who received prenatal care in one of 10 community clinics served by Compañeros En Salud. Participants were recruited if they gave birth anywhere other than the primary-level rural hospital and adjacent birth center supported by Compañeros En Salud, either at home or at other facilities. MeasurementsWe compared rates of birth at the hospital-birth center, other health facilities, and at home from 2017-2018. We conducted surveys and interviews with women who gave birth between January 2017-July 2018 at home or at facilities other than the hospital-birth center to understand perceptions of care and decision-making surrounding childbirth location. FindingsWe found no significant difference in rates of overall number of women birthing at the hospital-birth center from Compañeros En Salud-affiliated communities between 2017 and 2018 (p=0.36). Analysis of 158 surveys revealed distance (30.4%), time (27.8%), and costs (25.9%) as reasons for not birthing at the hospital-birth center. From 27 interviews, negative perceptions and experiences of the hospital included low-quality and disrespectful care, low threshold for medical interventions, and harm and suffering. Partners or family members influenced most decisions about childbirth location. Key ConclusionsInterventions to minimize logistical barriers may not be sufficient to overcome distance and perceptions of low-quality, disrespectful care. Implications for PracticeBetter understanding of complex decision-making around childbirth will guide Compañeros En Salud in developing interventions to further meet the needs and preferences of birthing women in rural Chiapas.

Essential newborn care practices in Benin: Are there differences by birth location?

Annually, about 60 infant deaths occur per 1000 live births in Benin; nearly one-half of these deaths occur during the neonatal period. Home- and health facility-based newborn care practices are essential for reducing neonatal death. The aim of this study was to explore relationships between location of childbirth and essential newborn care practices in the Republic of Benin, West Africa. We used cross-sectional data from the 2017 Benin Demographic and Health Survey. The study included 6831 women who had a recent live birth. We used multivariable logistic regression to examine associations between location of birth and early initiation of breastfeeding, breastfeeding support, and cord examination while adjusting for potential confounding factors. There was no significant difference in early initiation of breastfeeding by birth location. Compared to women with home births, those who gave birth in public hospitals, public health centers/clinics, and private health facilities had significantly higher odds of receiving breastfeeding support (public hospitals: OR: 1.71, 95% CI: 1.23-2.59; public health centers/clinics: OR: 2.06, 95% CI: 1.46-2.91; private clinics: OR: 1.97, 95% CI: 1.35-2.88). Compared with women who gave birth at home, those who gave birth in public health centers/clinics and private health facilities were twice as likely to report newborn cord examination (OR: 1.99, 95% CI: 1.41-2.79; OR: 1.97, 95% CI: 1.36-2.83, respectively). Despite the high prevalence of health facility births in Benin, the coverage of early newborn care is suboptimal, especially in public hospitals. Policies and public health interventions will be required, more so in public hospitals, to ensure that all mothers and newborns receive these potentially life-saving services.

Inequity in uptake of hospital-based childbirth care in rural Tanzania: analysis of the 2015-16 Tanzania Demographic and Health Survey.

Proportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications (comprehensive emergency obstetric care) is offered in hospitals, while in frontline, primary health care (PHC) facilities (health centres and dispensaries) mostly only routine childbirth care is available. With over half (54%) of rural births in facilities, we hypothesized the presence of socio-economic inequity in hospital-based childbirth uptake in rural Tanzania and explored whether this relationship was modified by parity. This inequity may compound the burden of greater mortality among the poorest women and their babies. Records for 4456 rural women from the 2015–16 Tanzania Demographic and Health Survey with a live birth in the preceding 5 years were examined. Proportions of births at each location (home/PHC/hospital) were calculated by demographic and obstetric characteristics. Multinomial logistic regression was used to obtain crude and adjusted odds ratios of home/PHC and hospital/PHC births based on household wealth, including interaction between wealth and parity. Post-estimation margins analysis was applied to estimate childbirth location by wealth and parity. Hospital-based childbirth uptake was inequitable. The gap between poorest and richest was less pronounced at first birth. Hospital-based care utilization was lowest (around 10%) among the poorest multiparous women, with no increase at high parity (≥5) despite higher risk. PHC-based childbirth care was used by a consistent proportion of women after the first birth (range 30–51%). The poorest women utilized it at intermediate parity, but at parity ≥5 mostly gave birth at home. In an effort to provide effective childbirth care to all women, context-specific strategies are required to improve hospital-based care use, and poor, rural, high parity women are a particularly vulnerable group that requires specific attention. Improving childbirth care in PHC and strengthening referral linkages would benefit a considerable proportion of women.

Combination of Interventions Needed to Improve Maternal Healthcare Utilization: A Multinomial Analysis of the Inequity in Place of Childbirth in Afghanistan.

Giving birth with a skilled birth attendant at a facility that provides emergency obstetric care services has better outcomes, but many women do not have access to these services in low- and middle-income countries. Individual, household, and societal factors influence women's decisions about place of birth. Factors influencing birthplace preference by type of provider and level of public facility are not well understood. Applying the Andersen Behavioral Model of healthcare services use, we explored the association between characteristics of women and their choice of childbirth location using a multinomial logistic regression, and conducted a scenario analysis to predict changes in the childbirth location by imposing various interventions. Most women gave birth at home (68.1%), while 15.1% gave birth at a public clinic, 12.1% at a public hospital, and 4.7% at a private facility. Women with higher levels of education, from households in the upper two wealth quintiles, and who had any antenatal care were more likely to give birth in public or private facilities than at home. A combination of multisector interventions had the strongest signals from the model for increasing the predicted probability of in-facility childbirths. This study enhances our understanding of factors associated with the use of public facilities and the private sector for childbirth in Afghanistan. Policymakers and healthcare providers should seek to improve equity in the delivery of health services. This study highlights the need for decisionmakers to consider a combination of multisector efforts (e.g., health, education, and social protection), to increase equitable use of maternal healthcare services.

Are childbirth location and mode of delivery associated with favorable early breastfeeding practices in hard to reach areas of Bangladesh?

Early initiation of breastfeeding within one hour of birth (EIBF) and no prelacteal feeding are WHO recommended practices for improving maternal and newborn health outcomes. Globally, EIBF can avert around 22% of newborn death. In recent years, Bangladesh has experienced increasing facility delivery coverage and cesarean section rates. However, the impact of these changes on early breastfeeding initiation in hard to reach areas (HtR) of the country is still poorly understood. Therefore, this study aimed to examine the independent associations between childbirth locations and mode of delivery with favorable early breastfeeding practices in four hard to reach areas of Bangladesh. We extracted data from a cross-sectional study conducted in four HtR areas of Bangladesh in 2017. A total of 2768 women, having birth outcomes in the past 12 months of the survey, were interviewed using structured questionnaires. EIBF and no prelacteal feeding were considered as favorable early breastfeeding practices. The categories of childbirth locations were defined by the place of birth (home vs. facility) and the delivery sector (public/NGO vs. private). The mode of delivery was categorized into vaginal delivery and cesarean section. Generalized linear models were used to test the independent associations while adjusting for potential confounders. The prevalence of EIBF practices were 69.6%(95% CI:67.8-71.3); 72.2%(95% CI:67.8-71.3) among home births Vs 63.0%(95% CI:59.5%-66.4%) among facility births. Around 73.9% (95% CI:72.3-75.6) mother's in the study areas reported no-prelacteal feeding. Compared to home births, women delivering in the facilities had lower adjusted odds of EIBF (aOR = 0.51; 95%CI:0.35-0.75). Cesarean section was found to be negatively associated with EIBF (aOR = 0.20; 95%CI:0.12-0.35), after adjusting for potential confounders. We could not find any significant associations between the place of birth and mode of delivery with no prelacteal feeding. This study found that facility births and cesarean deliveries were negatively associated with EIBF. Although the implementation of "Baby-Friendly Hospital Initiatives" could be a potential solution for improving EIBF and no prelacteal feeding practices, the challenges of reduced service availability and accessibility in HtR areas must be considered while devising effective intervention strategies. Future studies can explore potential interventions to promote early breastfeeding for facility births and cesarean deliveries in HtR areas.

Effect of social integration on childbirth return among internal migrant pregnant women: a nationally representative study in China

BackgroundSocial integration has been demonstrated to be associated with the health care use among migrants, but few studies have focused on migrant pregnant women. This study aims to explore the association between social integration and childbirth at woman’s hometown (childbirth return) of internal migrant pregnant women in China.MethodUsing the data of “Monitoring Data of Chinese Migrants” in 2014, a total of 3412 internal migrant pregnant women were included in this study. Social integration was measured by economic integration, acculturation, and identification. The childbirth locations of internal migrant pregnant women were divided into current residency and the woman’s hometown. Univariate logistic regression and two multivariable logistic regression models were employed to assess the association between social integration and childbirth return among internal migrant pregnant women.ResultOur study finds that 24.56% of migrant pregnant women choose to have a childbirth return. As for social integration, those who have their own house (OR = 0.351 95% CI 0.207–0.595) in current residence, who have been staying in current residence for at least 5 years (OR = 0.449; 95% CI 0.322–0.626), and who are willing to stay in the current residence for a long time (OR = 0.731; 95% CI 0.537–0.995) are less likely to have a childbirth return. Apart from social integration, our results also show that those migrant pregnant women who are older, who have higher education level, who have at least two family members in current residence, with a migration reason of work and business, who have established health record in the current residency, and who were not covered by medical insurances, are less likely to have a childbirth return.ConclusionSocial integration is negatively associated with childbirth return among internal migrant pregnant women in China. To improve the utilization of maternal care services for migrant pregnant women in current residence, targeted policies should be made to improve social integration status for migrant pregnant women.

Does the preference for location of childbirth change for successive births? Evidence from the states and regions of India.

Universal health coverage is central to the development agenda to achieve maternal and neonatal health goals. Although there is evidence of a growing preference for institutional births in India, it is important to understand the pattern of switching location of childbirth and the factors associated with it. This study used data from the fourth round of the National Family and Health Survey (NFHS-4) conducted in India in 2015-16. The study sample comprised 59,629 women who had had at least two births in the five years preceding the survey. Bivariate and multivariate logistic regression analyses were applied to the data. About 16.4% of the women switched their location of childbirth between successive births; 9.1% switched to a health facility contributing to a net increment of 1.9% in institutional delivery, varying greatly across states and regions. There was at least a 4 percentage point net increment in institutional births in Chhattisgarh, Bihar, Punjab and Haryana, but the shift was more in favour of home births in Madhya Pradesh, Odisha and West Bengal. Women with high parity and a large birth interval had higher odds of switching their place of childbirth, and this was in favour of a health facility, while women with higher education, from lower social groups, living in urban areas, who had not received four antenatal care visits, and who belonged to a higher wealth quintile had higher odds of switching their place of childbirth to a health facility, despite having lower odds of switching their childbirth location. The study provides evidence of women in India switching their location of childbirth for successive births, and this was more prevalent in areas where the rate of institutional delivery was low. Only a few states showed a higher net increment in favour of a health facility. This suggests that there is a need for action in specific states and regions of India to achieve universal health coverage.

Service utilization patterns for childbirth and neonatal mortality in the occupied Palestinian territory during conflict.

The global incidence of man-made crises has increased in the last decade. Evidence on deviations in service uptake during conflict is needed to better understand the link between conflict and adverse neonatal outcomes. We assessed the association between conflict intensity in the occupied Palestinian territory (oPt) at time of birth and (i) utilization patterns for childbirth across different providers; and (ii) neonatal mortality. We combined data on conflict intensity with four demographic and health surveys (2004, 2006, 2010 and 2014) that included nationally representative samples of women of childbearing age. Our exposure variable was casualties per 100000 population in defined sub-regions of the oPt. Our outcome specifications were a binary variable for neonatal deaths and a categorical variable for childbirth location. We used multivariate logistic and multinomial regressions to assess the associations. High conflict intensity was associated with fewer childbirths in the private sector (RR=0.97, P=0.04), and non-governmental organizations (RR=0.95, P=0.03) compared to public facilities. Conflict intensity was not associated with higher neonatal mortality beyond 2004. Policy implications include better preparedness in the public sector for childbirth during conflict and exploring reasons for the slow decline in neonatal mortality in the territory beyond conflict at time of birth.

Is fear of childbirth related to the woman's preferred location for giving birth? A Dutch low-risk cohort study.

BackgroundIn The Netherlands, women with low‐risk pregnancy are routinely given the option of home birth, providing a unique opportunity to study the relationship between fear of childbirth (FOC) and preference for childbirth location, and whether women experience higher FOC when the actual location differs from their preference.MethodsIn this prospective cohort study, 331 nulliparous and parous women completed a questionnaire at gestational week 30 (T1) and two months postpartum (T2). FOC was assessed using versions A (T1) and B (T2) of the Wijma Delivery Expectancy/Experience Questionnaire (W‐DEQ).ResultsAt T1, women who preferred home birth had significantly lower FOC compared with women who preferred a hospital birth (mean ± SD W‐DEQ scores: 55 ± 19.8 and 64 ± 18.3, respectively, P < .01). About 28% of women who responded at T2 gave birth at home. Congruence between the preferred and actual childbirth location was not predictive of FOC assessed at T2 when adjusted for obstetric and psychological variables. In an extended analysis, we found that except for prepartum FOC, the following variables also correlated with postpartum FOC: being referred because of complications and poor neonatal condition.ConclusionsCompared to women who prefer hospital birth, women who prefer home birth have lower prepartum and postpartum FOC. Giving birth at a location other than the preferred location does not appear to affect postpartum FOC. Whether giving birth at home or in the hospital, caregivers should pay extra attention to women with high FOC because they are vulnerable to postpartum FOC, especially after a complicated birth and referral.

Is childbirth location associated with higher rates of favourable early breastfeeding practices in Sub-Saharan Africa?

BackgroundFavourable early breastfeeding practices have a beneficial impact throughout an infants’ lifespan. Childbirth location is likely to affect these practices through support during the intrapartum and immediate postpartum period. This study aimed to investigate the association between childbirth location and favourable early breastfeeding practices in Sub-Saharan Africa (SSA).MethodsDemographic and Health Survey (2000–2013) data across 30 SSA countries were utilised. Childbirth location was categorised as home vs facility, and further into public vs private sector. Early breastfeeding practices included: early initiation of breastfeeding (EIBF) (within 1 hour of birth), and no prelacteal feeding (fed only breast milk in the first 3 days). Multivariate logistic regression models adjusted for confounders were used to assess this association.ResultsOverall, 50.0% (country range 32.6%-95.5%) of infants received EIBF and 61.0% had no prelacteal feeding. Compared with home births, facility deliveries had higher adjusted odds of EIBF (adjusted odds ratio, aOR = 1.39, 95% confidence interval (CI) = 1.30-1.48, P < 0.001) and no prelacteal feeding (aOR = 1.75, 95% CI = 1.63-1.89, P < 0.001). Private sector facilities had lower adjusted odds of no prelacteal feeding (aOR = 0.89, 95% CI = 0.81-0.99, P = 0.036) when compared to public sector facilities. There was no evidence to suggest delivery sector was associated with EIBF (aOR = 0.93, 95% CI = 0.85-1.03, P = 0.212).ConclusionsThis study showed early breastfeeding practices are suboptimal and are associated with delivery location in SSA. Further research is required to better understand how characteristics of care may explain these patterns in order to improve feeding practices.

Women’s childbearing location preferences in South Ethiopia: a qualitative study

Maternal mortality is unacceptably high in developing countries, and maternal health care service utilization is associated with improved maternal outcomes. We shed light on conditions that influence women’s preferences for childbirth location. Based on a qualitative descriptive design, 25 interviews were conducted with women of childbearing age in Southern Ethiopia in 2015. Previous experience of complications was the most common reason for using skilled attendants at the next childbirth. In addition, women’s limited decision-making authority and knowledge, as well as the quality of health care services and infrastructure, influenced childbirth location preferences. Home birth is still the norm, but there is growing interest in using health facilities and skilled attendants.

Association Between Loss of Hospital-based Obstetric Services and Birth Outcomes in Rural Counties in the United States

(JAMA. 2018;319(12):1239–1247) Between 2004 and 2014, hospital-based obstetric services have decreased from 55% to 46% in rural counties in the United States. Prior studies have shown that women and children in remote rural areas have delayed prenatal care initiation and higher rates of pregnancy hospitalizations, low birth weight, preterm births, and infant mortality. This retrospective cohort study examined whether the loss of rural obstetric services was associated with changes in location of childbirth or outcomes of care.

Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States

Hospital-based obstetric services have decreased in rural US counties, but whether this has been associated with changes in birth location and outcomes is unknown. To examine the relationship between loss of hospital-based obstetric services and location of childbirth and birth outcomes in rural counties. A retrospective cohort study, using county-level regression models in an annual interrupted time series approach. Births occurring from 2004 to 2014 in rural US counties were identified using birth certificates linked to American Hospital Association Annual Surveys. Participants included 4 941 387 births in all 1086 rural counties with hospital-based obstetric services in 2004. Loss of hospital-based obstetric services in the county of maternal residence, stratified by adjacency to urban areas. Primary outcomes were county rates of (1) out-of-hospital births; (2) births in hospitals without obstetric units; and (3) preterm births (<37 weeks' gestation). Between 2004 and 2014, 179 rural counties lost hospital-based obstetric services. Of the 4 941 387 births studied, the mean (SD) maternal age was 26.2 (5.8) years. A mean (SD) of 75.9% (23.2%) of women who gave birth were non-Hispanic white, and 49.7% (15.6%) were college graduates. Rural counties not adjacent to urban areas that lost hospital-based obstetric services had significant increases in out-of-hospital births (0.70 percentage points [95% CI, 0.30 to 1.10]); births in a hospital without an obstetric unit (3.06 percentage points [95% CI, 2.66 to 3.46]); and preterm births (0.67 percentage points [95% CI, 0.02 to 1.33]), in the year after loss of services, compared with those with continual obstetric services. Rural counties adjacent to urban areas that lost hospital-based obstetric services also had significant increases in births in a hospital without obstetric services (1.80 percentage points [95% CI, 1.55 to 2.05]) in the year after loss of services, compared with those with continual obstetric services, and this was followed by a decreasing trend (-0.19 percentage points per year [95% CI, -0.25 to -0.14]). In rural US counties not adjacent to urban areas, loss of hospital-based obstetric services, compared with counties with continual services, was associated with increases in out-of-hospital and preterm births and births in hospitals without obstetric units in the following year; the latter also occurred in urban-adjacent counties. These findings may inform planning and policy regarding rural obstetric services.

ANALISIS FAKTOR YANG MEMENGARUHI IBU DALAM MEMILIH PERSALINAN DI RUMAH OLEH BIDAN DI PUSKESMAS PANCUR BATU KABUPATEN DELI SERDANG TAHUN 2016

The location of childbirth is one of the factors which can psychologically influence mothers who are giving birth to babies. The wrong selection of location and childbirth aide will directly affect mothers’ health. The selection of the location and the aides of childbirth can be influenced by several factors such as the distance of health service facility, transportation, demographic location, and knowledge of searching for the right childbirth aide. Goals : The research is quantitative with cross sectional analytic survey. The method of the analysis was factor analysis in which the variables were reduced to one or two factors which influenced mothers to select the home birth by midwives. Method : The population was all mothers who gave birth to babies, aided by midwives at home, and 110 of them were used as the samples, using purposive sampling technique with inclusive and exclusive criteria. Result : The result of the factor analysis showed that of 12 variables, eight of them could be included in the factor analysis with MSA value &gt; 0.05. Of the eight factors, two of them became internal and external factors. Internal factor contributed 70%, while external factor contributed 77% in influencing mothers to select the location of childbirth at home. From the internal factor, it was found that childbirth environment was the most influencing factor (85.5%), while from the external factor, it was found that childbirth expense was the most influencing factor (84.1%). Conclusion : The conclusion of the research was that internal factor (childbirth environment) and external factor (childbirth expense) influenced mothers to select home birth by midwives in the working area of Batu Pancur Puskesmas. It is recommended that midwife professionalism should be improved in giving childbirth service so that people will be motivated to select health facility in giving birth to babies.

Early breastfeeding practices: Descriptive analysis of recent Demographic and Health Surveys.

The aim of this study was to describe early breastfeeding practices (initiation within 1 hr of birth, no prelacteal feeding, and a combination of both—“optimal” early breastfeeding) according to childbirth location in low‐ and middle‐income countries. Using data from the most recent Demographic and Health Survey (2000–2013) for 57 countries, we extracted information on the most recent birth for women aged 15–49 with a live birth in the preceding 24 months. Childbirth setting was self‐reported by location (home or facility) and subtype (home delivery with or without a skilled birth attendant; public or private facility). We produced overall world and four region‐level summary statistics by applying national population adjusted survey weights. Overall, 39% of children were breastfed within 1 hr of birth (region range 31–60%), 49% received no prelacteal feeding (41–65%), and 28% benefited from optimal early breastfeeding (21–46%). In South/Southeast Asia and Sub‐Saharan Africa, early breastfeeding outcomes were more favourable for facility births compared to home births; trends were less consistent in Latin America and Middle East/Europe. Among home deliveries, there was a higher prevalence of positive breastfeeding practices for births with a skilled birth attendant across all regions other than Latin America. For facility births, breastfeeding practices were more favourable among those taking place in the public sector. This study is the most comprehensive assessment to date of early breastfeeding practices by childbirth location. Our results suggest that skilled delivery care—particularly care delivered in public sector facilities—appears positively correlated with favourable breastfeeding practices.

A look back on how far to walk: Systematic review and meta-analysis of physical access to skilled care for childbirth in Sub-Saharan Africa

ObjectivesTo (i) summarize the methods undertaken to measure physical accessibility as the spatial separation between women and health services, and (ii) establish the extent to which distance to skilled care for childbirth affects utilization in Sub-Saharan Africa.MethodWe defined spatial separation as the distance/travel time between women and skilled care services. The use of skilled care at birth referred to either the location or attendant of childbirth. The main criterion for inclusion was any quantification of the relationship between spatial separation and use of skilled care at birth. The approaches undertaken to measure distance/travel time were summarized in a narrative format. We obtained pooled adjusted odds ratios (aOR) from studies that controlled for financial means, education and (perceived) need of care in a meta-analysis.Results57 articles were included (40 studied distance and 25 travel time), in which distance/travel time were found predominately self-reported or estimated in a geographic information system based on geographic coordinates. Approaches of distance/travel time measurement were generally poorly detailed, especially for self-reported data. Crucial features such as start point of origin and the mode of transportation for travel time were most often unspecified. Meta-analysis showed that increased distance to maternity care had an inverse association with utilization (n = 10, pooled aOR = 0.90/1km, 95%CI = 0.85–0.94). Distance from a hospital for rural women showed an even more pronounced effect on utilization (n = 2, pooled aOR = 0.58/1km increase, 95%CI = 0.31,1.09). The effect of spatial separation appears to level off beyond critical point when utilization was generally low.ConclusionAlthough the reporting and measurements of spatial separation in low-resource settings needs further development, we found evidence that a lack of geographic access impedes use. Utilization is conditioned on access, researchers and policy makers should therefore prioritize quality data for the evidence-base to ensure that women everywhere have the potential to access obstetric care.

Longitudinal Trends in Childbirth Practices in Ethiopia

Objectives This study examines the influence of women’s birth practices on their daughters’ location of childbirth in Ethiopia, investigating the importance of intergenerational patterns of care on contemporary birth practices. Methods A qualitative survey of women aged 60 and over in three cities in Ethiopia. Results Nearly all first generation women gave birth at home, but the majority of their daughters give birth in facilities. Perceptions of childbirth practices among both women and their daughters have shifted towards facility births, despite the prevalence of home birth in the previous generation. Conclusions Birth culture has experienced a profound shift in Ethiopia within one generation, especially in urban areas, where health facilities are more easily accessible. Older generations of women have positive attitudes towards facility birth, and can help influence their daughters to give birth with medical assistance. This aligns with both national and global maternal health policies which promote safe motherhood through facility birth.