Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Decision-making for birth location among women in Pakistan: evidence from national survey

Authors: Muhammad Iftikhar ul Husnain, Mudassar Rashid, Usman Shakoor

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

Login to get access

Abstract

Background

Pakistan ranks 149th in the maternal mortality ratio (MMR) and has failed to keep pace with other countries in the region, except Afghanistan, with respect to health indicators. Home deliveries are linked to a higher risk of maternal death; therefore, discouraging home deliveries is imperative to improve maternal health. This study provides a holistic view and analyses factors affecting home birth decisions within the context of maternal socio-demographic characteristics in Pakistan.

Methods

The study exploits the latest data from the Pakistan Demographic and Health Survey (2012–2013), which includes a nationally representative sample of 13,558 women aged 15–49 years. However, the sample was reduced to 6977 women who had given birth in the 5 years preceding the survey. Statistical techniques, including bi-variate and multivariate logistic regression, were used to analyse the data. The dependent variable was dichotomous and coded as 0 for home deliveries and 1 for deliveries at a health facility. The dependent variable was constructed based on information regarding the most recent birth in the 5 years preceding the survey.

Results

The study reveals that giving birth at home is highly prevalent among mothers in Pakistan (Baluchistan, 74%; Khyber-Pakhtunkhwa, 53%; Gilgit Baltistan, 46%; Punjab, 45% and Sindh, 34%) because of their difficulty obtaining permission to visit a health facility, financial barriers, the distance to health facilities and transportation. Substantial variation is observed when geo-demographic characteristics are considered. Higher home childbirth rates have been recorded in rural areas compared with those in urban areas (OR 1.32; p ≤ 0.000). The likelihood of home birth is highest (OR 2.67; p = 0.000) among women in Baluchistan province and lowest (OR 0.48; p = 0.000) among mothers in Punjab province. After controlling for all odds ratios and demographic characteristics, the parents’ education levels remain a significant factor (p = 0.000) that affects women’s decisions to deliver at home rather than at a health facility.

Conclusion

The study findings provide a better understanding of why women prefer to give birth at home. These results can help policymakers to introduce appropriate interventions to increase the number of deliveries at health facilities. These findings are expected to reduce maternal and neonatal mortality in Pakistan.
Literature
1.
Ackermann-Liebrich U, Voegeli T, Gunter-Witt K, Kunz I, Zullig M, Schindler C, Maurer M, Team ZS. Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. BMJ. 1996;313(7068):1313–8.CrossRefPubMedPubMedCentral
2.
Sørensen HT, Steffensen FH, Rothman KJ, Gillman MW, Fischer P, Sabroe S, Olsen J. Effect of home and hospital delivery on long-term cognitive function. Epidemiology. 2000;11(6):706–8.CrossRefPubMed
3.
Wagle RR, Sabroe S, Nielsen BB. Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal. BMC Pregnancy Childbirth. 2004;4(1):8.CrossRefPubMedPubMedCentral
4.
Walraven GE, Mkanje RJ, Roosmalen J, Van Dongen PW, Dolmans WM. Perinatal mortality in home births in rural Tanzania. Eur J Obstet Gynaecol Reprod Biol. 1995;58(2):131–4.CrossRef
5.
National Co-ordinating Agency for Population and Development (NCPDA). Maternal Deaths on the Rise in Kenya: A call to save Women’s lives. Policy brief no. 9 – June 2010. 2010.
6.
Moindi RO, Ngari MM, Nyambati VC, Mbakaya C. Why mothers still deliver at home: understanding factors associated with home deliveries and cultural practices in rural coastal Kenya, a cross-section study. BMC Public Health. 2016;16(1):114.CrossRefPubMedPubMedCentral
7.
Javed SA, Anjum MD, Imran W, Haider A, Shiraz A, Shaheen F, Ul Husnain MI. Correlates of preferences for home or hospital confinement in Pakistan: evidence from a national survey. BMC Pregnancy Childbirth. 2013;13(1):137.CrossRefPubMedPubMedCentral
8.
9.
Bibi S, Ghaffar S, Memon S, Memon S. Severe acute maternal morbidity (SAMM) in postpartum period requiring tertiary hospital care. Iran J Reprod Med. 2012;10(2):87.PubMedPubMedCentral
10.
Khan YP, Bhutta SZ, Munim S, Bhutta ZA. Maternal health and survival in Pakistan: issues and options. J Obstet Gynecol. 2009;31(10):920–9.
11.
Hasan IJ, Khanum A. Health care utilization during terminal child illness in squatter settlements of Karachi. J Pak Med Assoc. 2000;50(12):405–9.PubMed
12.
Stephenson R, Hennink M. Barriers to family planning service use among the urban poor in Pakistan. Asia Pac Popul J. 2004;19(2):5–26.
13.
Soliday E, Tremblay K, Gartstein M. Decisions in childbirth reported by a sample of US women. International Journal of Childbirth. 2015;5(2):61.CrossRef
14.
Singh S, Darroch JE, Ashford LS, Vlassoff M. Adding it up: the costs and benefits of investing in family planning and maternal and new born health. In: Guttmacher Institute; 2009.
15.
International: Ethiopia Demographic and Health Survey 2011, Maryland. USA: Central Statistical Agency of Ethiopia and ICF International Addis Ababa, Ethiopia and Calverton; CSA-Ethiopia IC, 2012. p. 2011.
16.
Sudhinaraset M, Beyeler N, Barge S, Diamond-Smith N. Decision-making for delivery location and quality of care among slum-dwellers: a qualitative study in Uttar Pradesh, India. BMC Pregnancy Childbirth. 2016;16(1):148.CrossRefPubMedPubMedCentral
17.
Belay A, Sendo E. Factors determining choice of delivery place among women of child bearing age in Dega Damot District, north west of Ethiopia: a community based cross-sectional study. BMC Pregnancy Childbirth. 2016;16(1):229.CrossRefPubMedPubMedCentral
18.
Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, Schellenberg D. Factors affecting home delivery in rural Tanzania. Tropical Med Int Health. 2007;12(7):862–72.CrossRef
19.
DHS, MEASURE. Demographic and health surveys. Calverton: MEASURE DHS; 2013.
20.
Sidney K, Tolhurst R, Jehan K, Diwan V, Costa A. The money is important but all women anyway go to hospital for childbirth nowadays’-a qualitative exploration of why women participate in a conditional cash transfer program to promote institutional deliveries in Madhya Pradesh, India. BMC Pregnancy Childbirth. 2016;16(1):47.CrossRefPubMedPubMedCentral
21.
22.
23.
Manchanda R, editor. SAGE series in human rights audits of peace processes: five-volume set. India: SAGE publications; 2015.
24.
25.
Ali SM. Gender and health care utilisation in Pakistan. Pak Dev Rev 2000:213–34.
26.
27.
National Institute of Popul Stud (NIPS) [Pakistan] and Macro International Inc: Pakistan Demographic and Health Survey 2006–07 Islamabad, Pakistan: National Institute of Popul Stud and Macro International Inc; 2008.
28.
Celik Y, Hotchkiss DR. The socio-economic determinants of maternal health care utilization in Turkey. Soc Sci Med. 2000;50(12):1797–806.CrossRefPubMed
29.
Navaneetham K, Dharmalingam A. Utilization of maternal health care services in southern India. Soc Sci Med. 2002;55(10):1849–69.CrossRefPubMed
30.
Alemi Kebede KH, Teklehaymanot AN. Factors associated with institutional delivery service utilization in Ethiopia. Int J Wom Health. 2016;8:463.CrossRef
31.
Sarker BK, Rahman M, Rahman T, Hossain J, Reichenbach L, Mitra DK. Reasons for preference of home delivery with traditional birth attendants (TBAs) in rural Bangladesh: a qualitative exploration. PLoS One. 2016;11(1):e0146161.CrossRefPubMedPubMedCentral
32.
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(05):671–92.CrossRefPubMed
33.
Sweet MA, Appelbaum MI. Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Dev. 2004 Sep 1;75(5):1435–56.CrossRefPubMed
34.
Mushi D, Mpembeni R, Jahn A. Effectiveness of community based safe motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania. BMC Pregnancy Childbirth. 2010;10(1):14.CrossRefPubMedPubMedCentral
35.
Van Eijk AM, Bles HM, Odhiambo F, Ayisi JG, Blokland IE, Rosen DH, Adazu K, Slutsker L, Lindblade KA. Use of antenatal services and delivery care among women in rural western Kenya: a community based survey. Reprod Health. 2006;3(1):2.
36.
Mwaniki PK, Kabiru EW, Mbugua GG. Utilisation of antenatal and maternity services by mothers seeking child welfare services in Mbeere District, Eastern Province, Kenya. E Afr Med J. 2002;79(4):184–7.
37.
Obermeyer CM, Potter JE. Maternal health care utilization in Jordan: a study of patterns and determinants. Stud Family Plann. 1991;22(3):177–87.CrossRef
38.
Gage AJ. Premarital childbearing, unwanted fertility and maternity care in Kenya and Namibia. Pop Stud. 1998;52(1):21–34.CrossRef
39.
Nankwanga A. Factors influencing utilisation of postnatal services in Mulago and Mengo Hospitals Kampala, Uganda. 2004. (Doctoral dissertation, University of the Western Cape).
40.
Garg R, Shyamsunder D, Singh T, Singh PA. Study on delivery practices among women in rural Punjab. Role of Medical Personnel in Promoting Appropriate Infant and Young Child Feeding. 2010;33(1):23–33.
41.
Kkonde A. Factors that influence pregnant women's choice of delivery site in Mukono district, Uganda.2010.(Doctoral dissertation).
42.
Prasad KR, Nagaraj K. Socio demographic correlates of place of delivery and person conducting the delivery in a rural community in Andhra Pradesh. J Human Ecolo. 2001;12(5):357–62.CrossRef
43.
Sychareun V, Hansana V, Somphet V, Xayavong S, Phengsavanh A, Popenoe R. Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study. BMC Pregnancy Childbirth. 2012;12(1):86.CrossRefPubMedPubMedCentral
44.
45.
Mumtaz Z, Salway S, Shanner L, Zaman S, Laing L. Addressing disparities in maternal health care in Pakistan: gender, class and exclusion. BMC Pregnancy Childbirth. 2012;12(1):80.CrossRefPubMedPubMedCentral
46.
Shah N, Rohra DK, Shams H, Khan NH. Home deliveries: reasons and adverse outcomes in women presenting to a tertiary care hospital. JPMA. 2010;60(7):555.
47.
48.
Some TD, Sombie I, Meda N. Women's perceptions of homebirths in two rural medical districts in Burkina Faso: a qualitative study. Reprod Health. 2011;8(1):3.CrossRefPubMedPubMedCentral
49.
Alkema L, New JR, Pedersen J, You D. Child mortality estimation 2013: an overview of updates in estimation methods by the United Nations inter-agency Group for Child Mortality Estimation. PLoS One. 2014 Jul 11;9(7):e101112.CrossRefPubMedPubMedCentral
50.
Yunus A, Iqbal S, Munawar R, Zakar R, Mushtaq SK, Sadaf F, Usman A. Determinants of postnatal care services utilization in Pakistan-insights from Pakistan demographic and health survey (PDHS) 2006-07. Middle-East J Sci Res. 2013;18(10):1440–7.
51.
Shrestha SK, Banu B, Khanom K, Ali L, Thapa N, Stray-Pedersen B, Devkota B. Changing trends on the place of delivery: why do Nepali women give birth at home? Reprod Health. 2012 Dec;9(1):25.CrossRefPubMedPubMedCentral
52.
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994 Apr 1;38(8):1091–110.CrossRefPubMed
53.
Bicego G, Curtis S, Raggers H, Kapiga S, Ngallaba S. Sumve survey on adult and childhood mortality Tanzania. In: In-depth study on estimating adult and childhood mortality in settings of high adult mortality; 1995.
54.
Hasnain S, Sheikh NH, Mehmood S. Socioeconomic factors affecting the accessibility to emergency obstetric care in a periurban area of District Lahore, Pakistan. Annals of King Edward Medical College. 2006;12(3).
55.
56.
57.
58.
59.
Hyyppä MT, Mäki J. Individual-level relationships between social capital and self-rated health in a bilingual community. Prev Med. 2001;32(2):148–55.CrossRefPubMed
60.
Lau JT, Yu A, Cheung JC, Leung SS. Studies on common illnesses and medical care utilization patterns of adolescents in Hong Kong. J Adolescent Health. 2000;27(6):443–52.CrossRef
61.
Ersdal HL, Singhal N, Msemo G, Ashish KC, Data S, Moyo NT, Evans CL, Smith J, Perlman JM, Niermeyer S. Successful implementation of helping babies survive and helping mothers survive programs—an Utstein formula for newborn and maternal survival. PLoS One. 2017;12(6):e0178073.CrossRefPubMedPubMedCentral
Metadata
Title
Decision-making for birth location among women in Pakistan: evidence from national survey
Authors
Muhammad Iftikhar ul Husnain
Mudassar Rashid
Usman Shakoor
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1844-8

Other articles of this Issue 1/2018

BMC Pregnancy and Childbirth 1/2018 Go to the issue

Research article

Trends and factors associated with early initiation of breastfeeding in Namibia: analysis of the Demographic and Health Surveys 2000–2013

Research article

Physical activity for antenatal and postnatal depression in women attempting to quit smoking: randomised controlled trial

Research article

Antiepileptic drug exposure in pregnancy and pregnancy outcome from national drug usage data

Research article

A randomized trial comparing the pharmacology of magnesium sulfate when used to treat severe preeclampsia with serial intravenous boluses versus a continuous intravenous infusion

Research article

How do informal information sources influence women’s decision-making for birth? A meta-synthesis of qualitative studies

Research article

Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health