Introduction
Materials and methods
Search strategy
Study selection and data extraction
Analysis and synthesis strategy
Results
Type of data source | Number of studies utilizing source* | Percent of all studies |
---|---|---|
Population-based / Household survey | 58 | 84.0 |
- Demographic Health Survey Data | 20 | 29.0 |
- Health and Demographic Surveillance Site Data | 6 | 9.0 |
Medical records / Facility assessments | 9 | 13.0 |
Facility-based Survey of Women | 4 | 6.0 |
Published Literature | 4 | 6.0 |
Geographic Information System Information | 2 | 3.0 |
Maternal factor | Country in which it was studied | Direction of influence | Cites |
---|---|---|---|
Maternal age | Botswana; Burkina-Faso; Ghana; Ivory Coast; Kenya; Malawi; Nigeria; Tanzania; 21 countries in Africa | Younger women more likely to deliver in a facility, except if very young (<18 years of age); inconsistently found significant | |
Maternal education | Botswana; Burkina Faso; Eritrea; Ethiopia; Ghana; Ivory Coast; Kenya; Malawi; Namibia; Nigeria; Tanzania; Uganda; multiple low-income, developing or African nations | Greater education is linked to higher levels of facility based delivery and skilled birth attendance | |
Religion | Ethiopia; Ghana; Nigeria; Uganda | Those who practice traditional or Muslim religions in some countries are less likely to deliver in a facility, although finding is not universal | |
Ethnicity | Burkina Faso; Ghana; Kenya; Nigeria; Tanzania; Uganda | Ethnicity has an inconsistent relationship with FBD. In some settings ethnic minorities are more likely to seek FBD, in other settings ethnic minorities are less likely to seek FBD | |
Region / province of residence | Ghana; Kenya; Rwanda; Tanzania; Uganda | Region, province of residence has an inconsistent relationship with FBD. In some nations there are strong regional and provincial differences, even after controlling for rural/urban status. In other nations, regional differences are largely explained by rural/urban or socioeconomic status | |
Urban / Rural residence | 45 developing countries; Botswana; Eritrea; Ethiopia; Ghana; Kenya; Mali; Namibia; Nigeria; Rwanda; Senegal; South Africa; Tanzania | Urban women more likely to deliver in a facility than rural women; however poverty is tightly linked to urban / rural status | |
Wealth / SES / economic variables | 31 countries in Africa; 45 developing countries; Botswana; Burkina Faso; Ghana; Kenya; Namibia; Nigeria; Rwanda; Tanzania; Uganda | Poorest women least likely to use delivery services; FBD seen as causing financial hardship; inequalities across wealth groups smallest in countries with highest female literacy rates | |
Maternal employment (status / occupation) | Eritrea; Ethiopia; Ghana; Kenya; Nigeria; Zimbabwe | Maternal employment positively linked to FBD | |
Health insurance coverage | Ghana; Kenya; Mali; Nigeria; Rwanda; Senegal; Tanzania | Insurance coverage, fee exemptions linked to greater FBD rates; Membership in a voluntary community-based health insurance program was linked to increased FBD | |
Parity / birth order | 73 countries; Botswana; Burkina Faso; Ethiopia; Ghana; Ivory Coast; Kenya; Malawi; Nigeria; Tanzania | Higher parity, lower likelihood of FBD; No previous births linked to FBD; Birth order higher than 4, FBD less likely; Lower in the birth order, FBD more likely | |
Marital status | Ethiopia; Kenya; Tanzania; Uganda; Zimbabwe | Marital status linked to FBD in some studies, not linked in others | |
Polygamous union | Ghana; Senegal | Less likely to have FBD | |
Empowerment / Autonomy | 31 countries in Africa; Eritrea; Ethiopia | Women with highest levels of empowerment most likely to seek FBD, have SBA; Other research suggests autonomy and wealth interact but autonomy alone is insufficient | |
Attitude toward importance of FBD / perceived need | 48 developing countries; Nigeria; Tanzania | "Childbirth is natural" - no need for FBD; "FBD is important" linked to higher utilization | |
Attitude toward skills of doctor vs. TBA | Kenya; Tanzania | Perceived similarity of skilled vs unskilled attendants linked to lower FBD rates | |
Embarrassment / fear of being shamed | Tanzania | Not having clean clothes for self or baby, embarrassment of poverty linked to lower FBD | [50] |
Discussion with male partner on place of delivery | Tanzania | Discussion with male partner linked to higher FBD rates | [21] |
Knowledge of pregnancy risk factors / safe delivery | Kenya; Tanzania | Greater knowledge linked to higher FBD rates | |
Completion of a birth plan | Uganda | Completion of a birth plan linked to FBD | [24] |
Concept of abnormal vs. normal pregnancy | Nigeria | "Normal" pregnancies mean home delivery is preferred | [63] |
Having means of transport to facility / vouchers for transport | Ghana; Mali; Senegal; Uganda | No transport means FBD less likely | |
Quality of previous delivery | Senegal | Poor quality previous delivery means less likelihood of FBD on subsequent deliveries | [62] |
Location of previous delivery | Kenya; Uganda | Location of previous delivery predicts subsequent delivery location | |
Pregnancy wantedness | Kenya | Desired pregnancies more likely to be delivered in facility | |
Birth complications / perceived problems | Tanzania; Zimbabwe | When problems arose, women reported desire to be in a facility; Complications during previous pregnancy predictive of FBD | |
Use of herbal drugs in pregnancy | Nigeria | Use of herbal drugs associated with lower FBD rates | [42] |
Desire to appear modern | Tanzania | Greater desire to appear modern linked to greater FBD | [50] |
Fear of episiotomy | Swaziland | Fear of episiotomy linked to lower FBD | [66] |
Precipitate Labor | Ghana; Swaziland | Decreased likelihood of FBD | |
Use of maternity waiting homes | Zimbabwe | Increased likelihood of FBD | [58] |
Social factor | Country in which it was studied | Direction of Influence | Cites |
---|---|---|---|
Non-male household head | Kenya | Increased likelihood of FBD | [59] |
Husband's occupation | Kenya; Nigeria | Non-farmers have higher rates of FBD | |
Husband / partner's education | Eritrea; Ethiopia; Kenya; Nigeria | Greater husband's education, greater FBD | |
Small family norm (community level) | Nigeria | Small family norm linked to greater use of SBA | [33] |
Stigma / risk of gossip / onlookers | Uganda | FBD puts women at risk of gossip, stigma, social devaluation | [67] |
Living in a socioeconomically disadvantaged neighborhood | Nigeria | Linked to lower likelihood of FBD | [17] |
Permission from husband, TBA, mother, or mother-in-law | Gambia | Needing permission linked to lower likelihood of FBD | [68] |
Social influence of others | Tanzania | Attitudes of others encourage / discourage FBD rates | [61] |
Village level: % of village who agree that FBD is important | Tanzania | Higher percent linked to greater FBD rates | [60] |
Village level: % of village who rated local facility as "excellent" | Tanzania | Higher percent linked to greater FBD rates; Unrelated in Mills study | |
Village level: % of village who attended 4+ ANC visits | Tanzania | Higher percent linked to greater FBD rates | [60] |
Village level: % of village who agreed doctors and nurses have good skills | Tanzania | Higher percent agreeing linked to higher FBD | [60] |
Village level: % of village who agreed TBAs have good skills | Tanzania | Higher percent agreeing TBAs have good skills linked to lower utilization of FBD | [60] |
Community perception of access to nearest facility | Ghana | Higher perception of access linked to higher FBD rates | [65] |
Traditional views on delivery and motherhood | Swaziland | More traditional views yield lower FBD rates | [66] |
Antenatal care factor | Country in which it was studied | Direction of influence | Cites |
---|---|---|---|
Attended ANC | Kenya | ANC attendance linked to higher likelihood of FBD | [31] |
Timing of first ANC visit (early onset of ANC) | Tanzania; Ghana | Earlier ANC initiation linked to greater likelihood of FBD; Later ANC linked to FBD | |
Number of ANC visits | Burkina Faso; Ghana; Ivory Coast; Kenya; Malawi; Tanzania | Fewer ANC visits linked to lower likelihood of FBD; 3+, 4+ visits linked to higher rates of FBD | |
Saw doctor at ANC | Ghana | Seeing a doctor at ANC linked to greater FBD | |
Quality of ANC | Ghana | Higher perceived quality linked to greater FBD | [54] |
Being advised to deliver in a facility during ANC | Ghana; Kenya; Tanzania | Higher likelihood of FBD | |
FACILITY FACTOR | |||
Distance to facility | Burkina Faso; Ghana; Kenya; Malawi; Mali; Nigeria; Senegal; Tanzania; Uganda; Zambia | Greater distance, lower likelihood of FBD | |
Cost | Ghana; Nigeria; Uganda | Greater cost associated with lower likelihood of FBD | |
Promptness of care | Nigeria | Perception of promptness of care linked to greater utilization | [48] |
Perceived quality of delivery care | Ghana; Nigeria; Tanzania | Individual perceptions about higher quality of care linked to higher FBD rates. One study showed no relationship between community perceptions of quality and individual FBD | |
Presence of any provider, presence of OB/GYN, 24-hour availability of provider | Nigeria | Higher likelihood of FBD | |
Availability of medicine, equipment, emergency obstetric care | Nigeria; Tanzania; Uganda; Zambia | Increased FBD when medicine, equipment, higher level of emergency obstetric care available | |
Staff attitudes / behavior | Nigeria; Swaziland; Tanzania; Uganda | Negative staff attitudes, abusive treatment at hands of HCPs related to lower FBD | |
Culturally unacceptable | Nigeria; Swaziland | Less likely to deliver in a facility | |
Previous delivery with male provider | Senegal | Less likely to deliver in a facility | [62] |
Electricity, running water, radio communication at facility | Uganda | Presence of infrastructure linked to higher FBD rates | [53] |
MACRO-LEVEL FACTOR | |||
Government share of health care spending | 42 low-income countries | Greater percentage of government spending, greater likelihood of SBA | [23] |
Female literacy rates (education) | 42 low-income countries | Higher rates of female literacy in a country associated with higher rates of SBA | |
Total health expenditures per capita | 42 low-income countries | Higher total health expenditures per capita associated with higher rates of SBA | |
Gross national income per capita | 21 sub-Saharan African countries | Higher gross national income per capita linked to FBD | [20] |
Aremu et al., 2011 - Nigeria | Babalola et al., 2009 - Nigeria | Hong et al., 2011 - Rwanda | Letamo et al., 2003 - Botswana | Magadi et al., 2000 - Kenya | Smith, Sulzbach, 2008 - Mali | Smith, Sulzbach, 2008 - Ghana | Stephenson et al., 2006-Malawi | Stephenson et al., 2006 - Kenya | Stephenson et al., 2006 - Tanz. | Stephenson et al., 2006 - B. Faso | Stephenson et al., 2006 - Ghana | Stephenson et al., 2006 - I. Coast | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Maternal age | * | * | * | ns | * | * | * | * | * | * | |||
Age at last birth | ns | * | |||||||||||
Maternal education | * | * | * | * | * | ns | ns | * | * | * | * | * | * |
Partner's education | * | ||||||||||||
Age x parity interaction | * | ||||||||||||
Parity / birth order | * | ns | * | * | * | ns | ns | * | * | ns | ns | * | * |
Marital status | * | * | * | ns | ns | ns | * | ||||||
Maternal occupation | * | * | |||||||||||
Religion | ns | ns | ns | * | * | ns | * | ns | |||||
Ethnicity | * | * | ns | ns | |||||||||
Region | ns | ns | ns | * | |||||||||
Rural / urban | ns | * | * | * | * | ns | * | * | ns | * | * | ||
Insurance | * | * | * | ns | |||||||||
Household wealth / SES | * | * | * | * | * | ns | * | * | * | * | * | * | * |
Neighborhood SES / slum residence | * | ||||||||||||
Pregnancy intendedness | * | ||||||||||||
Attitude toward family planning | ns | * | * | * | ns | ns | ns | ||||||
Exposure to family planning info | * | * | * | * | * | ns | |||||||
History of newborn death | ns | ns | |||||||||||
Ideal family size | ns | ||||||||||||
Prevalence of small family norm | * | * | ns | ns | ns | * | ns | ||||||
Media saturation | * | ||||||||||||
Ever used modern contraception | * | ||||||||||||
Previous hospital delivery | * | * | * | * | * | * | |||||||
Number of antenatal care visits | * | * | * | * | * | * | * | ||||||
Location / distance to nearest facility | * | ||||||||||||
Percent of women w/secondary + education | * | * | ns | * | * | ns | |||||||
Rainfall category of Primary Sampling Unit (PSU) | ns | * | ns | ns | ns | ns | |||||||
Percent of women in PSU w/1+ prior FBD | * | ns | * | * | * | * | |||||||
Total # of variables in model | 10 | 11 | 8 | 7 | 10 | 9 | 9 | 15 | 15 | 15 | 14 | 15 | 14 |