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 12 months. 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.