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The Role of Birth History in Determining Place of Delivery
According to World Health Organization, 800 women die every day due to preventable pregnancy related complications or child birth. Almost all of these women live in developing countries. In Uganda, it is estimated that 360 maternal deaths occur per 100,000 live births. The top five causes of maternal deaths are severe bleeding, unsafe abortion, infection, hypertensive conditions and obstructed labor. Delivery in a health facility with the assistance of a skilled provider is one intervention that can help save lives especially in complicated delivery cases. Nonetheless, although the use of antenatal care is high (94%) amongst pregnant Ugandan women, the proportion that deliver at health facilities still remain very low (36% rural, 79% urban). Various socioeconomic, cultural and infrastructural barriers have been examined as reasons for the low levels of facility delivery but less has been done investigating the personal factors that may drive this choice.
Objective
This study investigates how personal learning and information gathering about the risk of child birth influences the choice of where to deliver. It explores the extent to which individual and community perceptions of risk associated with child birth may play a role in that decision making process.
Data & Methods
Women’s birth history and maternal health services utilization data from the Uganda Demographic Health Survey is used. I develop a model to assess how learning about the risks of childbirth through information revealed in the form of the death of a child influences pregnant women’s behavior about accessing care in a health facility for child delivery. The hypothesized variables of interest are whether the woman in question had given birth to a child who subsequently died and the aggregate number of women who had experienced the death of a child in the cluster in which the woman lived. The main outcome is whether for her most recent birth the woman utilized services at a health facility or she delivered at home or with a traditional birth attendant. Other control variables included are education, age, wealth index, ethnicity, region and total number of children ever born.OLS and fixed effect regression models were estimated.
Results
Only the OLS estimate of the cluster infant deaths was significant. The negative sign of the relationship suggests that women who live in clusters where other women have experienced high numbers of child death are less likely to use a health facility for delivery. This is a surprising result. Nonetheless, although the estimated effect from the fixed effects model is not significant, the direction of the relationship made more intuitive sense. It showed a positive relationship indicating that women who had experienced previous child death were more likely to deliver at a health facility for their most recent birth. Ongoing analysis will confirm the robustness of these findings.
Conclusion
Programs targeted at women to encourage use of skilled provider services during pregnancy should take into account the critical role of the child birth risk learning network and how that affects the ultimate choice in place of delivery.