Contextual influences on the use of health facilities for childbirth in Africa.

Stephenson, R; Baschieri, A; Clements, S; Hennink, M; Madise, N; (2005) Contextual influences on the use of health facilities for childbirth in Africa. American journal of public health, 96 (1). pp. 84-93. ISSN 0090-0036 DOI:

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OBJECTIVES: Previous studies of maternal health-seeking behavior focused on individual- and household-level factors. We examined community-level influences on the decision to deliver a child in a health facility across 6 African countries. METHODS: Demographic and Health Survey data were linked with contextual data, and multilevel models were fitted to identify the determinants of childbirth in a health facility in the 6 countries. RESULTS: We found strong community-level influences on a woman's decision to deliver her child in a health facility. Several pathways of influence between the community and individual were identified. CONCLUSIONS: Community economic development, the climate of female autonomy, service provision, and fertility preferences all exert an influence on a woman's decision to seek care during labor, but significant community variation remains unexplained.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
PubMed ID: 16317204
Web of Science ID: 234314000017


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