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Open Access 01-12-2013 | Review

Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review

Authors: Cheryl A Moyer, Aesha Mustafa

Published in: Reproductive Health | Issue 1/2013

Abstract

While the most important factors associated with facility-based delivery (FBD) have been explored within individual countries in Africa, no systematic review has explored the factors associated with FBD across sub-Saharan Africa. A systematic search of the peer-reviewed literature was conducted to identify articles published in English from 1/1995-12/2011 that reported on original research conducted entirely or in part in sub-Saharan Africa and included a primary outcome variable of FBD, delivery location, or skilled birth attendance (SBA). Out of 1,168 citations identified, 65 met inclusion criteria. 62 of 65 were cross-sectional, and 58 of 65 relied upon household survey data. Fewer than two-thirds (43) included multivariate analyses. The factors associated with facility delivery were categorized as maternal, social, antenatal-related, facility-related, and macro-level factors. Maternal factors were the most commonly studied. This may be a result of the overwhelming reliance on household survey data – where maternal sociodemographic factors are likely to be well-represented and non-maternal factors may be less consistently and accurately represented. Multivariate analysis suggests that maternal education, parity / birth order, rural / urban residence, household wealth / socioeconomic status, distance to the nearest facility, and number of antenatal care visits were the factors most consistently associated with FBD. In conclusion, FBD is a complex issue that is influenced by characteristics of the pregnant woman herself, her immediate social circle, the community in which she lives, the facility that is closest to her, and context of the country in which she lives. Research to date has been dominated by analysis of cross-sectional household survey data. More research is needed that explores regional variability, examines longitudinal trends, and studies the impact of interventions to boost rates of facility delivery in sub-Saharan Africa.

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Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, Dwyer-Lindgren L, Lofgren KT, Phillips D, Atkinson C, Lopez AD, Murray CJ: Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: An updated systematic analysis. Lancet. 2011, 378 (9797): 1139-1165. 10.1016/S0140-6736(11)61337-8.CrossRefPubMed

WHO: Making pregnancy safer: The importance of the skilled birth attendant; A joint statement by WHO, ACM, and FIGO. 2004, Geneva

Wang W, Alva S, Wang S, Fort A: Levels and trends in the use of maternal health services in developing countries. DHS Comparative Reports No. 26. 2011, ICF Macro: Calverton, Maryland

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

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

Gabrysch S, Campbell O: Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy Childbirth. 2009, 9 (1): 34-10.1186/1471-2393-9-34.CrossRefPubMedPubMedCentral

STROBE Statement: Strengthening the reporting of observational studies in epidemiology.http://www.strobe-statement.org/index.php?id?=?strobe-home,

Ekirapa-Kiracho E, Waiswa P, Rahman MH, Makumbi F, Kiwanuka N, Okui O, Rutebemberwa E, Bua J, Mutebi A, Nalwadda G, Serwadda D, Pariyo GW, Peters DH: Increasing access to institutional deliveries using demand and supply side incentives: Early results from a quasi-experimental study. BMC Int Health Hum Rights. 2011, 11 (Suppl 1): S11-10.1186/1472-698X-11-S1-S11.CrossRefPubMedPubMedCentral

Penfold S, Harrison E, Bell J, Fitzmaurice A: Evaluation of the delivery fee exemption policy in Ghana: Population estimates of changes in delivery service utilization in two regions. Ghana Med Jour. 2007, 41 (3): 100-109.

10.

Stanton C, Blanc AK, Croft T, Choi Y: Skilled care at birth in the developing world: Progress to date and strategies for expanding coverage. J Biosoc Sci. 2007, 39 (1): 109-120. 10.1017/S0021932006001271.CrossRefPubMed

11.

Hondula DM, Rocklov J, Sankoh OA: Past, present, and future climate at select INDEPTH member Health and Demographic Surveillance Systems in Africa and Asia. Glob Health Action. 2012, 5: 74-86.PubMed

12.

Ye Y, Wamukoya M, Ezeh A, Emina JB, Sankoh O: Health and demographic surveillance systems: A step towards full civil registration and vital statistics system in sub-Sahara Africa?. BMC Public Health. 2012, 12: 741-2458–12-741-

13.

Houweling TA, Ronsmans C, Campbell OM, Kunst AE: Huge poor-rich inequalities in maternity care: An international comparative study of maternity and child care in developing countries. Bull World Health Organ. 2007, 85 (10): 745-754.CrossRefPubMedPubMedCentral

14.

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

15.

Rockers PC, Wilson ML, Mbaruku G, Kruk ME: Source of antenatal care influences facility delivery in rural Tanzania: A population-based study. Matern Child Health J. 2009, 13 (6): 879-885. 10.1007/s10995-008-0412-7.CrossRefPubMed

16.

Addai I: Determinants of use of maternal-child health services in rural Ghana. J Biosoc Sci. 2000, 32 (1): 1-15.PubMed

17.

Aremu O, Lawoko S, Dalal K: Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: A multilevel discrete choice analysis. Int J Womens Health. 2011, 3: 167-174.CrossRefPubMedPubMedCentral

18.

Idris SH, Gwarzo UMD, Shehu AU: Determinants of place of delivery among women in a semi-urban settlement in Zaria, northern Nigeria. Ann Afr Med. 2006, 5 (2): 68-72.

19.

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

20.

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.2006.11.004.CrossRefPubMed

21.

Mpembeni RN, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D, Mwakipa H: Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: Implications for achievement of MDG-5 targets. BMC Pregnancy Childbirth. 2007, 7: 29-10.1186/1471-2393-7-29.CrossRefPubMedPubMedCentral

22.

Mwaniki PK, Kabiru EW, Mbugua GG: Utilisation of antenatal and maternity services by mothers seeking child welfare services in Mbeere District, Eastern Province, Kenya. East Afr Med J. 2002, 79 (4): 184-187.CrossRefPubMed

23.

Kruk ME, Galea S, Prescott M, Freedman LP: Health care financing and utilization of maternal health services in developing countries. Health Policy Plan. 2007, 22 (5): 303-310. 10.1093/heapol/czm027.CrossRefPubMed

24.

Mulogo EM, Witte K, Bajunirwe F, Nabukera SK, Muchunguzi C, Batwala VK, Bagenda F, Farr C, Barry S: Birth plans and health facility based delivery in rural Uganda. East Afr Med J. 2006, 83 (3): 74-83.CrossRefPubMed

25.

Magadi M, Diamond I, Rodrigues RN: The determinants of delivery care in Kenya. Soc Biol. 2000, 47 (3–4): 164-188.PubMed

26.

Kunst AE, Houweling T: A global picture of poor-rich differences in the utilization of delivery care. Stud Health Serv Organ Policy. 2001, 17: 293-311.

27.

Bazant ES, Koenig MA, Fotso JC, Mills S: Women's use of private and government health facilities for childbirth in Nairobi's informal settlements. Stud Fam Plann. 2009, 40 (1): 39-50. 10.1111/j.1728-4465.2009.00185.x.CrossRefPubMed

28.

Fotso JC, Ezeh A, Madise N, Ziraba A, Ogollah R: What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya. Matern Child Health J. 2009, 13 (1): 130-137. 10.1007/s10995-008-0326-4.CrossRefPubMed

29.

Fotso JC, Ezeh A, Oronje R: Provision and use of maternal health services among urban poor women in Kenya: What do we know and what can we do?. J Urban Health. 2008, 85 (3): 428-442. 10.1007/s11524-008-9263-1.CrossRefPubMedPubMedCentral

30.

Fotso JC, Ezeh AC, Essendi H: Maternal health in resource-poor urban settings: How does women's autonomy influence the utilization of obstetric care services?. Reprod Health. 2009, 6: 9-10.1186/1742-4755-6-9.CrossRefPubMedPubMedCentral

31.

Ochako R, Fotso JC, Ikamari L, Khasakhala A: Utilization of maternal health services among young women in Kenya: Insights from the Kenya Demographic and Health Survey, 2003. BMC Pregnancy Childbirth. 2011, 11: 1-10.1186/1471-2393-11-1.CrossRefPubMedPubMedCentral

32.

Ahmed S, Creanga AA, Gillespie DG, Tsui AO: Economic status, education and empowerment: Implications for maternal health service utilization in developing countries. PLoS ONE [Electronic Resource]. 2010, 5 (6): e11190-10.1371/journal.pone.0011190.CrossRef

33.

Babalola S, Fatusi A: Determinants of use of maternal health services in Nigeria-looking beyond individual and household factors. BMC Pregnancy & Childbirth. 2009, 9: 43-10.1186/1471-2393-9-43.CrossRef

34.

Galaa SZ, Daare K: Understanding barriers to maternal child health services utilization in northern Ghana. J Soc Dev Africa. 2008, 23 (2): 127-155.

35.

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. 10.1016/j.socscimed.2005.11.034.CrossRefPubMed

36.

Hounton S, Chapman G, Menten J, De Brouwere V, Ensor T, Sombie 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.CrossRefPubMed

37.

Kruk ME, Prescott MR, Galea S: Equity of skilled birth attendant utilization in developing countries: Financing and policy determinants. Am J Public Health. 2008, 98 (1): 142-147. 10.2105/AJPH.2006.104265.CrossRefPubMedPubMedCentral

38.

McNamee P, Ternent L, Hussein J: Barriers in accessing maternal healthcare: Evidence from low-and middle-income countries. Expert Rev Pharmacoecon Outcomes Res. 2009, 9 (1): 41-10.1586/14737167.9.1.41.CrossRefPubMed

39.

Mekonnen Y, Mekonnen A: Factors influencing the use of maternal healthcare services in Ethiopia. J Health Popul Nutr. 2003, 21 (4): 374-382.PubMed

40.

Nuwaha F, Amooti-Kaguna B: Predictors of home deliveries in Rakai District, Uganda. Af J Reproductive Health. 1999, 3 (2): 79-86. 10.2307/3583363.CrossRef

41.

Oguntunde O, Aina O, Ibrahim MS, Umar HS, Passano P: Antenatal care and skilled birth attendance in three communities in Kaduna State, Nigeria. Afr J Reprod Health. 2010, 14 (3): 89-96.

42.

Olusanya BO, Alakija OP, Inem VA: Non-uptake of facility-based maternity services in an inner-city community in Lagos, Nigeria: An observational study. J Biosoc Sci. 2010, 42 (3): 341-358. 10.1017/S0021932009990526.CrossRefPubMed

43.

Uzochukwu BS, Onwujekwe OE, Akpala CO: Community satisfaction with the quality of maternal and child health services in southeast Nigeria. East Afr Med J. 2004, 81 (6): 293-299.CrossRefPubMed

44.

van den Broek NR, White SA, Ntonya C, Ngwale M, Cullinan TR, Molyneux ME, Neilson JP: Reproductive health in rural Malawi: A population-based survey. BJOG. 2003, 110 (10): 902-908.CrossRefPubMed

45.

Wanjira C, Mwangi M, Mathenge E, Mbugua G, Ng'ang'a Z: Delivery practices and associated factors among mothers seeking child welfare services in selected health facilities in Nyandarua South District, Kenya. BMC Public Health. 2011, 11: 360-10.1186/1471-2458-11-360.CrossRefPubMedPubMedCentral

46.

Woldemicael G: Do women with higher autonomy seek more maternal health care? Evidence from Eritrea and Ethiopia. Health Care Women Int. 2010, 31 (7): 599-620. 10.1080/07399331003599555.CrossRefPubMed

47.

Zere E, Oluwole D, Kirigia JM, Mwikisa CN, Mbeeli T: Inequities in skilled attendance at birth in Namibia: A decomposition analysis. BMC Pregnancy Childbirth. 2011, 11: 34-10.1186/1471-2393-11-34.CrossRefPubMedPubMedCentral

48.

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. 10.1016/j.socscimed.2006.04.019.CrossRefPubMed

49.

Akazili J, Doctor HV, Aboky L, Hodgson A, Phillips JF: Is there any relationship beween antenatal care and place of delivery? Findings from rural northern Ghana. Afr J Health Sciences. 2011, 18 (1–2): 62-73.

50.

Spangler SA, Bloom SS: Use of biomedical obstetric care in rural Tanzania: The role of social and material inequalities. Soc Sci Med. 2010, 71 (4): 760-768. 10.1016/j.socscimed.2010.05.025.CrossRefPubMed

51.

De Allegri M, Ridde V, Louis VR, Sarker M, Tiendrebeogo J, Ye M, Muller O, Jahn A: Determinants of utilisation of maternal care services after the reduction of user fees: A case study from rural Burkina Faso. Health Policy. 2011, 99 (3): 210-218. 10.1016/j.healthpol.2010.10.010.CrossRefPubMed

52.

Hong R, Ayad M, Ngabo F: Being insured improves safe delivery practices in Rwanda. J Community Health. 2011, 36 (5): 779-784. 10.1007/s10900-011-9376-4.CrossRefPubMed

53.

Mbonye AK, Asimwe JB: Factors associated with skilled attendance at delivery in Uganda: Results from a national health facility survey. Int J Adolesc Med Health. 2010, 22 (2): 249-255.PubMed

54.

Adanu RM: Utilization of obstetric services in Ghana between 1999 and 2003. Afr J Reprod Health. 2010, 14 (3): 153-158.PubMed

55.

Cronje HS, Joubert G, Chapman RD, de Winnaar B, Bam RH: Utilisation of maternity services by black women in rural and urban areas of the Orange Free State. S Afr Med J. 1995, 85 (8): 762-765.PubMed

56.

Smith KV, Sulzbach S: Community-based health insurance and access to maternal health services: Evidence from three West African countries. Soc Sci Med. 2008, 66 (12): 2460-2473. 10.1016/j.socscimed.2008.01.044.CrossRefPubMed

57.

Montagu D, Yamey G, Visconti A, Harding A, Yoong J: Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data. PLoS One. 2011, 6 (2): e17155-10.1371/journal.pone.0017155.CrossRefPubMedPubMedCentral

58.

van den Heuvel OA, de Mey WG, Buddingh H, Bots ML: Use of maternal care in a rural area of Zimbabwe: A population-based study. Acta Obstet Gynecol Scand. 1999, 78 (10): 838-846. 10.1080/j.1600-0412.1999.781002.x.CrossRefPubMed

59.

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

60.

Kruk ME, Rockers PC, Mbaruku G, Paczkowski MM, Galea S: Community and health system factors associated with facility delivery in rural Tanzania: A multilevel analysis. Health Policy. 2010, 97 (2–3): 209-216.CrossRefPubMed

61.

Danforth EJ, Kruk ME, Rockers PC, Mbaruku G, Galea S: Household decision-making about delivery in health facilities: Evidence from Tanzania. J Health Popul Nutr. 2009, 27 (5): 696-703.PubMedPubMedCentral

62.

Faye A, Niane M, Ba I: Home birth in women who have given birth at least once in a health facility: Contributory factors in a developing country. Acta Obstet Gynecol Scand. 2011, 90 (11): 1239-1243. 10.1111/j.1600-0412.2011.01163.x.CrossRefPubMed

63.

Ejembi CL, Atli-Muaza M, Chirdan O, Ezeh HO, Sheidu S: Utilization of maternal health services by rural Hausa women in Zaria environs, northern Nigeria: Has primary health care made a difference?. J of Comm Med and Prim Health Care. 2004, 16 (2): 47-54.

64.

Gage AJ: Barriers to the utilization of maternal health care in rural Mali. Soc Sci Med. 2007, 65 (8): 1666-1682. 10.1016/j.socscimed.2007.06.001.CrossRefPubMed

65.

Mills S, Williams JE, Adjuik M, Hodgson A: Use of health professionals for delivery following the availability of free obstetric care in northern Ghana. Matern Child Health J. 2008, 12 (4): 509-518. 10.1007/s10995-007-0288-y.CrossRefPubMed

66.

Uyirwoth GP, Itsweng MD, Mpai S, Nchabeleng E, Nkoane H: Obstetrics service utilisation by the community in Lebowa, northern Transvaal. East Afr Med J. 1996, 73 (2): 91-94.PubMed

67.

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

68.

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

69.

Gabrysch S, Cousens S, Cox J, Campbell OM: The influence of distance and level of care on delivery place in rural Zambia: A study of linked national data in a geographic information system. PLoS Med / Public Libr Sc. 2011, 8 (1): e1000394-CrossRef

70.

Tann CJ, Kizza M, Morison L, Mabey D, Muwanga M, Grosskurth H, Elliott AM: Use of antenatal services and delivery care in Entebbe, Uganda: A community survey. BMC Pregnancy & Childbirth. 2007, 7: 23-10.1186/1471-2393-7-23.CrossRef

71.

Osubor KM, Fatusi AO, Chiwuzie JC: Maternal health-seeking behavior and associated factors in a rural Nigerian community. Matern Child Health J. 2006, 10 (2): 159-169. 10.1007/s10995-005-0037-z.CrossRefPubMed

72.

Kruk ME, Paczkowski M, Mbaruku G, de Pinho H, Galea S: Women's preferences for place of delivery in rural Tanzania: A population-based discrete choice experiment. Am J Public Health. 2009, 99 (9): 1666-1672. 10.2105/AJPH.2008.146209.CrossRefPubMedPubMedCentral

73.

Bellows NM, Bellows BW, Warren C: Systematic Review: The use of vouchers for reproductive health services in developing countries: Systematic review. Trop Med Int Health. 2011, 16 (1): 84-96. 10.1111/j.1365-3156.2010.02667.x.CrossRefPubMed

74.

Arur A, Gitonga N, O'Hanlon B, Kundu F, Senkaali M, Ssemujju R: Insights from innovations: Lessons from designing and implementing family planning / reproductive health voucher programs in Kenya and Uganda. 2009

75.

Janisch CP, Albrecht M, Wolfschuetz A, Kundu F, Klein S: Vouchers for health: A demand side output-based aid approach to reproductive health services in Kenya. Glob Public Health. 2010, 5 (6): 578-594. 10.1080/17441690903436573.CrossRefPubMed

76.

Erulkar AS, Ettyang LI, Onoka C, Nyagah FK, Muyonga A: Behavior change evaluation of a culturally consistent reproductive health program for young Kenyans. Int Fam Plan Perspect. 2004, 30 (2): 58-67.CrossRefPubMed

77.

Amooti-Kaguna B, Nuwaha F: Factors influencing choice of delivery sites in Rakai district of Uganda. Soc Sci Med. 2000, 50 (2): 203-213.CrossRefPubMed

78.

Magoma M, Requejo J, Campbell OM, Cousens S, Filippi V: High ANC coverage and low skilled attendance in a rural Tanzanian district: A case for implementing a birth plan intervention. BMC Pregnancy Childbirth. 2010, 10: 13-10.1016/S0277-9536(99)00275-0.CrossRefPubMedPubMedCentral

79.

Cotter K, Hawken M, Temmerman M: Low use of skilled attendants' delivery services in rural Kenya. J Health Popul Nutr. 2006, 24 (4): 467-471. 10.1186/1471-2393-10-13.PubMedPubMedCentral

80.

Martey JO: Utilization of maternal health services in Ejisu District?. West Afr J Med. 1995, 14 (1): 24-28.PubMed

81.

Nilses C, Nystrom L, Munjanja S, Lindmark G: Self-reported reproductive outcome and implications in relation to use of care in women in rural Zimbabwe. Acta Obstet Gynecol Scand. 2002, 81 (6): 508-515.CrossRefPubMed

82.

Wilkinson D, Cutts F, Ntuli N, Abdool Karim SS: Maternal and child health indicators in a rural South African health district. S Afr Med J. 1997, 87 (4): 456-459. 10.1034/j.1600-0412.2002.810606.x.PubMed

Title: Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review
Authors: Cheryl A Moyer
Aesha Mustafa
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: Reproductive Health / Issue 1/2013
Electronic ISSN: 1742-4755
DOI: https://doi.org/10.1186/1742-4755-10-40

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