Contextual influences on the use of health facility for childbirth in Africa

Stephenson, Rob, Baschieri, Angela, Clements, Steve, Hennink, Monique and Madise, Nyovani (2006) Contextual influences on the use of health facility for childbirth in Africa. American Journal of Public Health, 96, (1), 84-93. (doi:10.2105/AJPH.2004.057422).


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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
Digital Object Identifier (DOI): doi:10.2105/AJPH.2004.057422
ISSNs: 0090-0036 (print)
Related URLs:
Subjects: H Social Sciences > HA Statistics
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
R Medicine > RA Public aspects of medicine
Divisions : University Structure - Pre August 2011 > School of Social Sciences > Social Statistics
ePrint ID: 35141
Accepted Date and Publication Date:
Date Deposited: 15 May 2006
Last Modified: 31 Mar 2016 12:02
Explaining areal variations in reproductive health in east & west africa
Funded by: ESRC National Centre for Research Methods (R000239664)
1 April 2002 to 31 May 2004

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