Factors contributing for the low uptake of institutional delivery

Abstract

Background: Many women and newborn die at the time of labor and birth. Although institutional delivery services can avert maternal and newborn deaths and permanent disabilities, it is challenging to provide institutional delivery for every mother who gave births. Hence, it is crucial to understand the factors associated with low uptake of institutional delivery to design effective strategy. Objective: The aim of this study was to assess factors contributing for the low uptake of institutional delivery in South Achefer District, West Gojam Zone, Amhara Region, Ethiopia Methods: Community based un-matched case control study complemented with exploratory qualitative study was conducted in south Achefer using pretested structured questionnaire on a total of 374 (187 cases and 187 controls) from May to November, 2011. The study group was classified as cases if they gave birth at home and controls if they gave birth in the health institution in the last one year. Four focused group discussions and four individual in-depth interviews were conducted for qualitative study. Finally, quantitative data analyzed using SPSS and bivariat and multivariate analyses were employed. The qualitative part analyzed in themes. Results: multiple logistic regression analysis showed that women educational status (AOR= 2.38, 95%CI=1.077, 5.28), residence (AOR=10.44, 95%CI=5.11, 21.31), attitude towards institutional delivery (AOR=3.35, 95%CI=1.87, 6.01), duration of labor (AOR=4.01, 95%CI=2.17, 7.41), birth preparation (AOR=2.57, 95%CI=1.23, 5.39) and husband preference (AOR=5.51, 95%CI=2.82, 10.77) were significantly associated with institutional delivery. Quality health service and traditional beliefs were also determinants of institutional delivery. Conclusion and recommendations: The factors contributing for the low uptake of institutional delivery were women’s educational status, place of residence, traditional practices and beliefs and the quality of the health service. Emphasis should be given to educate women, behavioral change communication and accessing quality health service to increase the institutional delivery utilization. ..............................Thesis available at ACIPH Library