Contextual Influences on the Use of Health Facilities for Childbirth in Africa

Rob Stephenson, Emory University
Steve Clements, University of Southampton
Angela Baschieri, University of Southampton
Nyovani Madise, African Population and Health Research Center (APHRC)

Studies of maternal health seeking behavior have focused on individual and household level factors. This analysis examines community level influences on the decision to deliver a child in a health facility across six African countries. Demographic and Health Survey data are linked with contextual data, and multilevel models are fitted to identify the determinants of childbirth in a health facility in the six countries. There are 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. Community economic development, the climate of female autonomy and fertility preferences all exert an influence on a woman’s decision to seek care during labor, although significant community variation remains unexplained. The results demonstrate the hierarchy of influences, from the individual, household and community, that influence a woman’s decision to deliver her child in a health facility.