Introduction:
In Ethiopia, despite existent intensive efforts to improve maternal health,
the proportion of births delivered at home remain
s high and is still the top priority among the
national health threats. The study aimed to exam
ine effects of individual and community-level
factors in women’s decision to deliver
at home versus in a health facility.
Methods:
Data for this study were
obtained from the nati
onally representative 2011
Ethiopia Demographic and Health Survey (E
DHS 2011) and focused on a sample from 576
communities of 7,908 women whose most recent birt
hs were within five years preceding the
survey. The data were analyzed using a two leve
l-mixed-effects logistic regression model to
determine the individual and community-level
factors associated with place of delivery.
Results:
In Ethiopia, 88% of deliveries took place at home. Both individual and
community-level factors were a
ssociated with women’s choice
for place of delivery. Lower
educational levels of mothers (OR=2.74; 95% CI: 1.84, 4.70) and their hu
sbands (OR=2.31; 95%
CI: 1.68, 3.18) were both positively
associated with the
odds of giving birth at home. The net
odds of home delivery among mothers without ante
natal care (ANC) visits for their recent
pregnancy was 3.7 times higher than among mother
s who made the recommended four or more
ANC visits (OR=3.72; 95% CI: 2.85, 4.83). Non-e
xposure to radio or television messages
(OR=1.51; 95% CI: 1.13, 2.01), parity of six or
more births, (OR=2.68, 95% CI: 1.96, 3.68) and
perceived problems reaching health faciliti
es due to distance (OR=1.29, 95% CI: 1.03, 1.62)
were positively associated with
home birth. With regard to the community-level characteristics,
rural communities (OR=4.67, 95% CI: 3.06, 7.11),
pastoralist communities (OR=4.53, 95% CI:
2.81, 7.28), communities with highe
r poverty levels (OR=1.49; 95% CI: 1.08, 2.22), and those
with lower ANC utilization (OR=2.01, 95% CI:
1.42, 2.85) and women in areas with perceived
problem of distance to health facilities (O
R=1.29; 95% CI: 1.03, 1.62) ha
d a positive influence
on women to give birth at home.
Conclusion:
Not only individual characteristics of
the women but also community-level
factors determine women’s decision
to deliver at home. Thus e
fforts to decrease the proportion
of births delivered at home in Ethiopia shoul
d focus both on individuals and on communities.