Stephenson, Rob, Baschieri, Angela, Clements, Steve, Hennink, Monique and Madise, Nyovani
Contextual influences on the use of health facility for childbirth in Africa
American Journal of Public Health, 96, (1), . (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.
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