Home birth in women who have given birth at least once in a health facility: Contributory factors in a developing country

Objective. To study the link between patients' satisfaction about received services in health facilities and the choice of future delivery place of women who had delivered at least once in a facility. Design. Cross-sectional study. Setting. Health district Gossas in Senegal. Sample. Three hundred and seventy-three women who gave birth in the last 12months. Methods. Data were collected using a questionnaire during an interview. Logistic regression was used to explore the determinants of childbirth at home using the Andersen behavioral model. Main Outcome Measures. Place of delivery and satisfaction at reception and conduct of delivery. Results. The average age was 28±6years. Among the women interviewed, 97% were married, 53% being in a polygamous system, and 18% were educated. Forty-seven per cent of them were satisfied with the quality of the last delivery made within a health facility. The prevalence of home birth was 22%. Home births were more frequent among women in a polygamous marriage [odds ratio (OR) 1.85; 95% confidence interval (CI) 1.01-3.14], with no means of transportation (OR 1.68; 95% CI 1.02-3.95) and who lived more than 5km from a health facility (OR 2.24; 95% CI 1.21-4.15). Poor quality of delivery in a health facility (OR 2.52; 95% CI 1.36-4.65) or a delivery done by a male provider (OR 3.90; 95% CI 2.30-6.65) were also risk factors for the choice of home delivery. Conclusions. Particular emphasis should be placed on training healthcare providers to improve the quality of service provided to patients in health facilities. © 2011 Nordic Federation of Societies of Obstetrics and Gynecology.