Socioeconomic, Cultural, and Healthcare Determinants of Home versus Facility-Based Deliveries among Women of Reproductive Age
DOI:
https://doi.org/10.62497/irjgp.218Keywords:
Home Childbirth, Institutional Delivery, Maternal Health, Antenatal Care, Reproductive Age Women, Rural Health, BirthAbstract
Background: Maternal health outcomes remain suboptimal in rural areas of Pakistan, particularly in Khyber Pakhtunkhwa (KPK), due to persistent disparities in access to skilled birth attendance and institutional delivery services.
Objective: To determine the prevalence and socioeconomic, maternal, institutional, economic, and cultural determinants influencing the choice of home versus facility-based deliveries among women of reproductive age (18–49 years) in rural areas of Khyber Pakhtunkhwa, Pakistan.
Methodology: This comparative cross-sectional study was conducted from January 2024 to December 2024 among 350 women who had delivered within the last six months. Data were collected through structured interviews using a validated questionnaire. Descriptive statistics, Chi-square test, and binary logistic regression analyses were performed using SPSS version 26 to identify factors associated with the place of delivery.
Results: Among 350 participants, 183 (52.29%) had home deliveries, while 167 (47.71%) delivered in healthcare facilities. Most respondents were aged 26–35 years (48.86%), married (97.71%), and belonged to poor households (56.29%). Maternal illiteracy was observed in 63.71% of women, while 47.14% of husbands were also illiterate. Antenatal care (ANC) attendance was reported by 67.43% of women, whereas 32.57% did not receive ANC services. More than half of respondents were knowledgeable about delivery complications (57.71%), and 65.14% had previous experience with facility-based delivery. Significant predictors of home delivery included low maternal education (AOR = 2.58), poor wealth status (AOR = 2.76), lack of ANC attendance (AOR = 3.41), poor transport access (AOR = 3.62), poor knowledge of delivery complications (AOR = 2.49), long distance to health facilities (AOR = 2.21), husband-dominated decision-making (AOR = 1.95), and perception of home delivery as non-threatening (AOR = 2.27) (p < 0.05 for all).
Conclusion: Home delivery remains slightly more prevalent than institutional delivery in rural Khyber Pakhtunkhwa, Pakistan, mainly due to socioeconomic deprivation, limited healthcare accessibility, and strong cultural influences. Strengthening maternal education, improving transportation and healthcare access, and promoting antenatal care utilization may enhance institutional delivery practices and improve maternal health outcomes.
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