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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2009

Open Access 01-12-2009 | Research article

Still too far to walk: Literature review of the determinants of delivery service use

Authors: Sabine Gabrysch, Oona MR Campbell

Published in: BMC Pregnancy and Childbirth | Issue 1/2009

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Abstract

Background

Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. The main conceptual framework in this field implicitly looks at home births with complications. We expand this to include "preventive" facility delivery for uncomplicated childbirth, and review the kinds of determinants studied in the literature, their hypothesized mechanisms of action and the typical findings, as well as methodological difficulties encountered.

Methods

We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1) sociocultural factors, (2) perceived benefit/need of skilled attendance, (3) economic accessibility and (4) physical accessibility.

Results

There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables.

Conclusion

Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider as many influential factors as possible in any analysis of delivery service use. The increasing availability of georeferenced data provides the opportunity to link health facility data with large-scale household data, enabling researchers to explore the influences of distance and service quality.
Appendix
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Literature
1.
Lawn JE, Cousens S, Zupan J: 4 million neonatal deaths: when? Where? Why?. Lancet. 2005, 365 (9462): 891-900. 10.1016/S0140-6736(05)71048-5.CrossRefPubMed
2.
Ronsmans C, Graham WJ: Maternal mortality: who, when, where, and why. Lancet. 2006, 368 (9542): 1189-1200. 10.1016/S0140-6736(06)69380-X.CrossRefPubMed
3.
Stanton C, Lawn JE, Rahman H, Wilczynska-Ketende K, Hill K: Stillbirth rates: delivering estimates in 190 countries. Lancet. 2006, 367 (9521): 1487-1494. 10.1016/S0140-6736(06)68586-3.CrossRefPubMed
4.
5.
6.
Campbell OM, Graham WJ: Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006, 368 (9543): 1284-1299. 10.1080/09540120050042918.CrossRefPubMed
7.
Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med. 1994, 38 (8): 1091-1110. 10.1016/0277-9536(94)90226-7.CrossRefPubMed
8.
Fishbein M: The role of theory in HIV prevention. AIDS Care. 2000, 12 (3): 273-278. 10.1016/j.socscimed.2004.01.006.CrossRefPubMed
9.
Say L, Raine R: A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ. 2007, 85 (10): 812-819.CrossRefPubMedPubMedCentral
10.
Burgard S: Race and pregnancy-related care in Brazil and South Africa. Soc Sci Med. 2004, 59 (6): 1127-1146. 10.1016/S0277-9536(03)00140-0.CrossRefPubMed
11.
Elo IT: Utilization of maternal health-care services in Peru: the role of women's education. Health Transit Rev. 1992, 2 (1): 49-69.PubMed
12.
Glei DA, Goldman N, Rodriguez G: Utilization of care during pregnancy in rural Guatemala: does obstetrical need matter?. Soc Sci Med. 2003, 57 (12): 2447-2463. 10.1363/3200606.CrossRefPubMed
13.
Navaneetham K, Dharmalingam A: Utilization of maternal health care services in Southern India. Soc Sci Med. 2002, 55 (10): 1849-1869. 10.1016/j.socscimed.2006.11.004.CrossRefPubMed
14.
Reynolds HW, Wong EL, Tucker H: Adolescents' use of maternal and child health services in developing countries. Int Fam Plan Perspect. 2006, 32 (1): 6-16. 10.1016/j.socscimed.2004.04.007.CrossRefPubMed
15.
16.
Magadi MA, Agwanda AO, Obare FO: A comparative analysis of the use of maternal health services between teenagers and older mothers in sub-Saharan Africa: evidence from Demographic and Health Surveys (DHS). Soc Sci Med. 2007, 64 (6): 1311-1325. 10.1016/j.socscimed.2005.11.034.CrossRefPubMed
17.
Duong DV, Binns CW, Lee AH: Utilization of delivery services at the primary health care level in rural Vietnam. Soc Sci Med. 2004, 59 (12): 2585-2595. 10.1016/j.socscimed.2004.04.007.CrossRefPubMed
18.
Gyimah SO, Takyi BK, Addai I: Challenges to the reproductive-health needs of African women: on religion and maternal health utilization in Ghana. Soc Sci Med. 2006, 62 (12): 2930-2944. 10.1177/146642409411400304.CrossRefPubMed
19.
20.
Nwakoby BN: Use of obstetric services in rural Nigeria. J R Soc Health. 1994, 114 (3): 132-136. 10.1177/146642409411400304.CrossRefPubMed
21.
Letamo G, Rakgoasi SD: Factors associated with non-use of maternal health services in Botswana. J Health Popul Nutr. 2003, 21 (1): 40-47.PubMed
22.
Onah HE, Ikeako LC, Iloabachie GC: Factors associated with the use of maternity services in Enugu, southeastern Nigeria. Soc Sci Med. 2006, 63 (7): 1870-1878. 10.2105/AJPH.2004.057422.CrossRefPubMed
23.
Stekelenburg J, Kyanamina S, Mukelabai M, Wolffers I, van Roosmalen J: Waiting too long: low use of maternal health services in Kalabo, Zambia. Trop Med Int Health. 2004, 9 (3): 390-398. 10.1111/j.1365-3156.2004.01202.x.CrossRefPubMed
24.
Stephenson R, Baschieri A, Clements S, Hennink M, Madise N: Contextual influences on the use of health facilities for childbirth in Africa. Am J Public Health. 2006, 96 (1): 84-93. 10.2105/AJPH.2004.057422.CrossRefPubMedPubMedCentral
25.
Mesko N, Osrin D, Tamang S, Shrestha BP, Manandhar DS, Manandhar M, Standing H, Costello AM: Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components. BMC Int Health Hum Rights. 2003, 3 (1): 3-10.1016/S0968-8080(03)02176-1.CrossRefPubMedPubMedCentral
26.
Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, Schellenberg D: Factors affecting home delivery in rural Tanzania. Trop Med Int Health. 2007, 12 (7): 862-872. 10.1016/j.socscimed.2004.12.022.CrossRefPubMed
27.
Kyomuhendo GB: Low use of rural maternity services in Uganda: impact of women's status, traditional beliefs and limited resources. Reprod Health Matters. 2003, 11 (21): 16-26. 10.1016/S0968-8080(03)02176-1.CrossRefPubMed
28.
Brentlinger PE, Sanchez-Perez HJ, Cedeno MA, Morales LG, Hernan MA, Micek MA, Ford D: Pregnancy outcomes, site of delivery, and community schisms in regions affected by the armed conflict in Chiapas, Mexico. Soc Sci Med. 2005, 61 (5): 1001-1014. 10.2307/2061874.CrossRefPubMed
29.
De Broe S: Diversity in the use of pregnancy-related care among ethnic groups in Guatemala. J Fam Plann Reprod Health Care. 2005, 31 (3): 199-205. 10.1783/1471189054483889.CrossRefPubMed
30.
Pebley AR, Goldman N, Rodriguez G: Prenatal and delivery care and childhood immunization in Guatemala: do family and community matter?. Demography. 1996, 33 (2): 231-247. 10.2307/2061874.CrossRefPubMed
31.
Potter JE: Utilizacion de los servicios de salud materna en el Mexico rural [Use of maternal health services in rural Mexico]. Salud Publica Mex. 1988, 30 (3): 387-402.PubMed
32.
Short S, Zhang F: Use of maternal health services in rural China. Popul Stud (Camb). 2004, 58 (1): 3-19. 10.1136/jech.50.4.451.CrossRef
33.
Celik Y, Hotchkiss DR: The socio-economic determinants of maternal health care utilization in Turkey. Soc Sci Med. 2000, 50 (12): 1797-1806. 10.1016/S0277-9536(99)00418-9.CrossRefPubMed
34.
Toan NV, Hoa HT, Trong PV, Hojer B, Persson LA, Sundstrom K: Utilisation of reproductive health services in rural Vietnam; are there equal opportunities to plan and protect pregnancies?. J Epidemiol Community Health. 1996, 50 (4): 451-455. 10.1136/jech.50.4.451.CrossRefPubMedPubMedCentral
35.
Addai I: Determinants of use of maternal-child health services in rural Ghana. J Biosoc Sci. 2000, 32 (1): 1-15.PubMed
36.
Magadi M, Diamond I, Rodrigues RN: The determinants of delivery care in Kenya. Soc Biol. 2000, 47 (3-4): 164-188.PubMed
37.
Yanagisawa S, Oum S, Wakai S: Determinants of skilled birth attendance in rural Cambodia. Trop Med Int Health. 2006, 11 (2): 238-251. 10.1080/00324720600895934.CrossRefPubMed
38.
Stephenson R, Tsui AO: Contextual influences on reproductive health service use in Uttar Pradesh, India. Stud Fam Plann. 2002, 33 (4): 309-320. 10.1111/j.1728-4465.2002.00309.x.CrossRefPubMed
39.
Gage AJ, Guirlene Calixte M: Effects of the physical accessibility of maternal health services on their use in rural Haiti. Popul Stud (Camb). 2006, 60 (3): 271-288. 10.1002/(SICI)1099-1050(199607)5:4<333::AID-HEC202>3.0.CO;2-K.CrossRef
40.
Gage AJ: Barriers to the utilization of maternal health care in rural Mali. Soc Sci Med. 2007, 65 (8): 1666-1682. 10.1363/3201706.CrossRefPubMed
41.
Hodgkin D: Household characteristics affecting where mothers deliver in rural Kenya. Health Econ. 1996, 5 (4): 333-340. 10.1002/(SICI)1099-1050(199607)5:4<333::AID-HEC202>3.0.CO;2-K.CrossRefPubMed
42.
Furuta M, Salway S: Women's position within the household as a determinant of maternal health care use in Nepal. Int Fam Plan Perspect. 2006, 32 (1): 17-27. 10.1016/0277-9536(95)00411-4.CrossRefPubMed
43.
Grosse RN, Auffrey C: Literacy and health status in developing countries. Annu Rev Public Health. 1989, 10: 281-297. 10.1093/ije/31.6.1192.CrossRefPubMed
44.
Raghupathy S: Education and the use of maternal health care in Thailand. Soc Sci Med. 1996, 43 (4): 459-471. 10.1111/j.1728-4465.2003.00032.x.CrossRefPubMed
45.
Singh-Manoux A, Clarke P, Marmot M: Multiple measures of socio-economic position and psychosocial health: proximal and distal measures. Int J Epidemiol. 2002, 31 (6): 1192-1199. 10.1353/dem.2001.0001. discussion 1199–1200CrossRefPubMed
46.
Falkingham J: Inequality and changes in women's use of maternal health-care services in Tajikistan. Stud Fam Plann. 2003, 34 (1): 32-43. 10.1111/j.1728-4465.2003.00032.x.CrossRefPubMed
47.
48.
Bloom SS, Wypij D, Das Gupta M: Dimensions of women's autonomy and the influence on maternal health care utilization in a north Indian city. Demography. 2001, 38 (1): 67-78. 10.1353/dem.2001.0001.CrossRefPubMed
49.
50.
Li J: Gender inequality, family planning, and maternal and child care in a rural Chinese county. Soc Sci Med. 2004, 59 (4): 695-708. 10.1016/j.socscimed.2003.11.041.CrossRefPubMed
51.
Obermeyer CM, Potter JE: Maternal health care utilization in Jordan: a study of patterns and determinants. Stud Fam Plann. 1991, 22 (3): 177-187. 10.2307/1966644.CrossRefPubMed
52.
53.
Marston C, Cleland J: Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Popul Stud (Camb). 2003, 57 (1): 77-93. 10.1017/S002193200100339X.CrossRef
54.
Amooti-Kaguna B, Nuwaha F: Factors influencing choice of delivery sites in Rakai district of Uganda. Soc Sci Med. 2000, 50 (2): 203-213. 10.1016/S0277-9536(99)00275-0.CrossRefPubMed
55.
Griffiths P, Stephenson R: Understanding users' perspectives of barriers to maternal health care use in Maharashtra, India. J Biosoc Sci. 2001, 33 (3): 339-359. 10.1017/S002193200100339X.CrossRefPubMed
56.
D'Ambruoso L, Abbey M, Hussein J: Please understand when I cry out in pain: women's accounts of maternity services during labour and delivery in Ghana. BMC Public Health. 2005, 5: 140-10.1016/S0277-9536(01)00148-4.CrossRefPubMedPubMedCentral
57.
Nilses C, Knutsson A: Förlossningsvård i Addis Abeba, Etiopien: Trots tillgängliga klinker föder de flesta kvinnor hemma [Obstetrics in Addis Abeba, Ethiopia: In spite of access to clinics, most women give birth at home]. Lakartidningen. 2002, 99 (39): 3862-3864.PubMed
58.
Paul BK, Rumsey DJ: Utilization of health facilities and trained birth attendants for childbirth in rural Bangladesh: an empirical study. Soc Sci Med. 2002, 54 (12): 1755-1765. 10.1016/S0277-9536(01)00148-4.CrossRefPubMed
59.
Afsana K, Rashid SF: The challenges of meeting rural Bangladeshi women's needs in delivery care. Reprod Health Matters. 2001, 9 (18): 79-89. 10.1016/S0968-8080(01)90094-1.CrossRefPubMed
60.
MacKeith N, Chinganya OJ, Ahmed Y, Murray SF: Zambian women's experiences of urban maternity care: results from a community survey in Lusaka. Afr J Reprod Health. 2003, 7 (1): 92-102. 10.2307/3583349.CrossRefPubMed
61.
62.
63.
Hounton S, Chapman G, Menten J, De Brouwere V, Ensor T, Sombié I, Meda N, Ronsmans C: Accessibility and utilisation of delivery care within a Skilled Care Initiative in rural Burkina Faso. Trop Med Int Health. 2008, 13 Suppl 1: 44-52. 10.1111/j.1365-3156.2008.02086.x.CrossRefPubMed
64.
Mayhew M, Hansen PM, Peters DH, Edward A, Singh LP, Dwivedi V, Mashkoor A, Burnham G: Determinants of skilled birth attendant utilization in Afghanistan: a cross-sectional study. Am J Public Health. 2008, 98 (10): 1849-1856. 10.2105/AJPH.2007.123471.CrossRefPubMedPubMedCentral
65.
66.
Telfer ML, Rowley JT, Walraven GE: Experiences of mothers with antenatal, delivery and postpartum care in rural Gambia. Afr J Reprod Health. 2002, 6 (1): 74-83. 10.2307/3583148.CrossRefPubMed
67.
Anwar I, Sami M, Akhtar N, Chowdhury ME, Salma U, Rahman M, Koblinsky M: Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programmes in Bangladesh. Bull World Health Organ. 2008, 86 (4): 252-259. 10.2471/BLT.07.042754.CrossRefPubMedPubMedCentral
68.
Chowdhury RI, Islam MA, Gulshan J, Chakraborty N: Delivery complications and healthcare-seeking behaviour: the Bangladesh Demographic Health Survey, 1999–2000. Health Soc Care Community. 2007, 15 (3): 254-264.CrossRefPubMed
69.
Sharma SK, Sawangdee Y, Sirirassamee B: Access to health: women's status and utilization of maternal health services in Nepal. J Biosoc Sci. 2007, 39 (5): 671-692. 10.1017/S0021932007001952.CrossRefPubMed
70.
Rahman MH, Mosley WH, Ahmed S, Akhter HH: Does service accessibility reduce socioeconomic differentials in maternity care seeking? Evidence from rural Bangladesh. J Biosoc Sci. 2008, 40 (1): 19-33. 10.1017/S0021932007002258.CrossRefPubMed
71.
Bolam A, Manandhar DS, Shrestha P, Ellis M, Malla K, Costello AM: Factors affecting home delivery in the Kathmandu Valley, Nepal. Health Policy Plan. 1998, 13 (2): 152-158. 10.1093/heapol/13.2.152.CrossRefPubMed
72.
Mahmud Khan M, Hotchkiss DR, Berruti AA, Hutchinson PL: Geographic aspects of poverty and health in Tanzania: does living in a poor area matter?. Health Policy Plan. 2006, 21 (2): 110-122. 10.1093/heapol/czj008.CrossRefPubMed
73.
Montgomery MR, Hewett PC: Urban poverty and health in developing countries: household and neighborhood effects. Demography. 2005, 42 (3): 397-425. 10.1353/dem.2005.0020.CrossRefPubMed
74.
75.
Anson O: Utilization of maternal care in rural HeBei Province, the People's Republic of China: individual and structural characteristics. Health Policy. 2004, 70 (2): 197-206. 10.1016/j.healthpol.2004.03.001.CrossRefPubMed
76.
77.
Chowdhury ME, Ronsmans C, Killewo J, Anwar I, Gausia K, Das-Gupta S, Blum LS, Dieltiens G, Marshall T, Saha S, et al: Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study. Lancet. 2006, 367 (9507): 327-332. 10.1016/S0140-6736(06)68070-7.CrossRefPubMed
78.
Greenland S, O'Rourke K: On the bias produced by quality scores in meta-analysis, and a hierarchical view of proposed solutions. Biostatistics. 2001, 2 (4): 463-471. 10.1093/biostatistics/2.4.463.CrossRefPubMed
79.
Ikeako LC, Onah HE, Iloabachie GC: Influence of formal maternal education on the use of maternity services in Enugu, Nigeria. J Obstet Gynaecol. 2006, 26 (1): 30-34. 10.1080/01443610500364004.CrossRefPubMed
Metadata
Title
Still too far to walk: Literature review of the determinants of delivery service use
Authors
Sabine Gabrysch
Oona MR Campbell
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2009
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-9-34

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