Document Type : Research Article

Authors

1 Department of Epidemiology and Biostatistics, School of Public Health, Zahedan University of Medical Sciences, Zahedan, Iran

2 Health Promotion Research Centre, Zahedan University of Medical Sciences, Mashahir Square, Zahedan, Iran

3 Pregnancy Health Research Center, Zahedan University of Medical Sciences, Mashahir Square, Zahedan, Iran

Abstract

Background: Free-of-charge vaginal deliveries have been offered as part of the Health Transformation Plan (HTP) in Iran, but still a high proportion of deliveries are occurring at home. This study aimed to investigate the reasons for home deliveries after the implementation of HTP in southeast of Iran.
Methods: This case-control study included women who gave birth at home between September 2015 and September 2016 for their last pregnancy; considered as cases (n=300), and women who delivered at a health facility (hospital or Safe Delivery Posts), assigned to the control group (n= 600). Data were collected during face to face interview using a 77-item semi-structured questionnaire. A multivariable logistic regression technique was used to identify independent predictors of home delivery.
Results: Women who were worried about giving birth at a teaching hospital (OR=1.9, 95% CI:1.3 -2.8), women with negative experiences in the previous delivery (OR=1.6, 95% CI:1.0-2.4), illiterates (OR=3.8, 95% CI: 2.0-7.4), individuals with primary/secondary education (OR=2.3, 95% CI: 1.3 - 4.4), women with no health insurance (OR=5.1, 95% CI: 3.5- 7.4), if the decision on choosing the place of birth was made by the women alone (OR=12.7, 95% CI: 7-22.8), women with financial constraints (OR=1.7, 95% CI: 1.2-2.4), women with precipitate labour (OR=2.4, 95% CI: 1.7-3.5) and women with fear of the hospital environment (OR= 1.6, 95% CI: 1.1- 2.4) were more likely to deliver at home.
Conclusions: Our findings highlight socio-economic and cultural barriers that need to be addressed to reduce home deliveries among the disadvantaged women.

Keywords

1. World Health Organization. Maternal mortality Fact sheet; 2019. [cited 2020 March 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality. ## 2. World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience; 2018. ## 3. Zielinski R, Ackerson K, Low KL. Planned home birth: Benefits, risks, and opportunities. International Journal of Women's Health. 2015;7:361. doi: 10.2147/IJWH.S55561. ## 4. Adelaja LM. A Survey of Home Delivery and Newborn Care Practices among Women in a Suburban Area of Western Nigeria. ISRN Obstet Gynecol. 2011;2011:983542. doi: 10.5402/2011/983542. PubMed PMID: 21804945; PubMed Central PMCID: PMC3143458. ## 5. Cofie LE, Barrington C, Singh K, Sodzi-Tettey S, Akaligaung A. Birth location preferences of mothers and fathers in rural Ghana: Implications for pregnancy, labor and birth outcomes. BMC Pregnancy and Childbirth. 2015;15:165. doi: 10.1186/s12884-015-0604-2. PubMed PMID: 26265087; PubMed Central PMCID: PMC4534058. ## 6. Khatri RB, Dangi TP, Gautam R, Shrestha KN, Homer CSE. Barriers to utilization of childbirth services of a rural birthing center in Nepal: a qualitative study. PLoS One. 2017;12(5):e0177602. doi: 10.1371/journal.pone.0177602. PubMed PMID: 28493987; PubMed Central PMCID: PMC5426683. ## 7. Moudi Z, Tabatabaie MG, Tabatabaei SM, Vedadhir A. Safe Delivery Posts: an intervention to provide equitable childbirth care services to vulnerable groups in Zahedan, Iran. Midwifery. 2014;30(10):1073-81. doi: 10.1016/j.midw.2013.06.011. PubMed PMID: 23866686. ## 8. Moradi-Lakeh M, Vosoogh-Moghaddam A. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns. Int J Health Policy Manag. 2015;4(10):637-40. doi: 10.15171/ijhpm.2015.160. PubMed PMID: 26673172; PubMed Central PMCID: PMC4594102. ## 9. Lawshe CH. A quantitative approach to content validity. Personnel Psychology. 1975;28(4):563-575. doi: 10.1111/j.1744-6570.1975.tb01393.x. ## 10. Karkee R, Binns CW, Lee AH. Determinants of facility delivery after implementation of safer mother programme in Nepal: a prospective cohort study. BMC Pregnancy Childbirth. 2013;13:193. doi: 10.1186/1471-2393-13-193. PubMed PMID: 24139382; PubMed Central PMCID: PMC3816171. ## 11. Abebe F, Berhane Y, Girma B. Factors associated with home delivery in Bahirdar, Ethiopia: a case control study. BMC Res Notes. 2012;5:653. doi: 10.1186/1756-0500-5-653. PubMed PMID: 23176369; PubMed Central PMCID: PMC3554461. ## 12. Tebekaw Y, James Mashalla Y, Thupayagale-Tshweneagae G. Factors influencing Women’s preferences for places to give birth in Addis Ababa, Ethiopia. Obstet Gynecol Int. 2015;2015:439748. doi: 10.1155/2015/439748. PubMed PMID: 26413095; PubMed Central PMCID: PMC4568048. ## 13. Caulfield T, Onyo P, Byrne A, Nduba J, Nyagero J, Morgan A, et al. Factors influencing place of delivery for pastoralist women in Kenya: a qualitative study. BMC Womens Health. 2016;16:52. doi: 10.1186/s12905-016-0333-3. PubMed PMID: 27506199; PubMed Central PMCID: PMC4979142. ## 14. Foroghi Rad P, Abbasi Marani F, Safavi Sh, Haghani H. The Reasons of Home Delivery in Koohdasht City. IJN. 2006;18(44):23-9. Persian. ## 15. Liabsuetrakul T, Oumudee N. Effect of health insurance on delivery care utilization and perceived delays and barriers among southern Thai women. BMC Public Health. 2011;11:510. doi: 10.1186/1471-2458-11-510. PubMed PMID: 21711550; PubMed Central PMCID: PMC3142511. ## 16. Otis KE, Brett JA. Barriers to hospital births: why do many Bolivian women give birth at home? Rev Panam Salud Publica. 2008;24(1):46-53. doi: 10.1590/s1020-49892008000700006. PubMed PMID: 18764994. ## 17. Lukumar P, Pathmeswaran A. Factors associated with home deliveries in Thampalakamam, Trincomalee. Ceylon Med J. 2006;51(2):59-62. doi: 10.4038/cmj.v51i2.1354. PubMed PMID: 17180810. ## 18. Sialubanje C, Massar K, Hamer DH, Ruiter RAC. Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study. BMC Pregnancy Childbirth. 2015;15:216. doi: 10.1186/s12884-015-0652-7. PubMed PMID: 26361976; PubMed Central PMCID: PMC4567794. ## 19. Bukar M, Jauro YS. Home births and postnatal practices in madagali, North. Eastern Nigeria. Niger J Clin Pract. 2013;16(2):232-7. doi: 10.4103/1119-3077.110151. PubMed PMID: 23563468. ## 20. Fikre AA, Demissie M. Prevalence of institutional delivery and associated factors in Dodota Woreda (district), Oromia regional state, Ethiopia. Reprod Health. 2012;9:33. doi: 10.1186/1742-4755-9-33. PubMed PMID: 23241397; PubMed Central PMCID: PMC3546055. ## 21. Fantahun M. Factors affecting ANC attendants and preference of delivery by pregnancy women in Gulale Woreda. Ethio j Health Dev. 1992;6(2):17-22. ## 22. Sychareun V, Hansana V, Somphet V, Xayavong S, Phengsavanh A, Popenoe R. Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study. BMC Pregnancy Childbirth. 2012;12:86. doi: 10.1186/1471-2393-12-86. PubMed PMID: 22925107; PubMed Central PMCID: PMC3449206. ## 23. Nawal D, Goli S. Birth preparedness and its effect on place of delivery and post-natal check-ups in Nepal. PLoS One. 2013;8(5):e60957. doi: 10.1371/journal.pone.0060957. PubMed PMID: 23690921; PubMed Central PMCID: PMCPMC3655026. ## 24. Titaley CR, Hunter CL, Dibley MJ, Heywood P. Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia. BMC Pregnancy Childbirth. 2010;10:43. doi: 10.1186/1471-2393-10-43. PubMed PMID: 20701762; PubMed Central PMCID: PMCPMC2928756. ## 25. Ogolla JO. Factors associated with home delivery in west pokot county of Kenya. Advances in Public Health. 2015;2015. doi: 10.1155/2015/493184. ## 26. Sarker BK, Rahman M, Rahman T, Hossain J, Reichenbach L, Mitra DK. Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs) in Rural Bangladesh: AQualitative Exploration. PLoS One. 2016;11(1):e0146161. doi: 10.1371/journal.pone.0146161. PubMed PMID: 26731276; PubMed Central PMCID: PMCPMC4701391. ## 27. Mageda K, Mmbaga EJ. Prevalence and predictors of institutional delivery among pregnant mothers in Biharamulo district, Tanzania: a cross-sectional study. Pan Afr Med J. 2015;21:51. doi: 10.11604/pamj.2015.21.51.6347. PubMed PMID: 26405487; PubMed Central PMCID: PMCPMC4564411. ## 28. Sidney K, Tolhurst R, Jehan K, Diwan V, De Costa A. 'The money is important but all women anyway go to hospital for childbirth nowadays' - a qualitative exploration of why women participate in a conditional cash transfer program to promote institutional deliveries in Madhya Pradesh, India. BMC Pregnancy Childbirth. 2016;16:47. doi: 10.1186/s12884-016-0834-y. PubMed PMID: 26944258; PubMed Central PMCID: PMCPMC4779242. ## 29. Tabatabaie MG, Moudi Z, Vedadhir A. Home birth and barriers to referring women with obstetric complications to hospitals: a mixed-methods study in Zahedan, southeastern Iran. Reprod Health. 2012;9:5. doi: 10.1186/1742-4755-9-5. PubMed PMID: 22433468; PubMed Central PMCID: PMC3353872. ## 30. Moyer CA, Adongo PB, Aborigo RA, Hodgson A, Engmann CM, DeVries R. “It’s up to the woman’s people”: how social factors influence facility-based delivery in Rural Northern Ghana. Matern Child Health J. 2014;18(1):109-119. doi: 10.1007/s10995-013-1240-y. PubMed PMID: 23423857. ## 31. Homer CS, Thornton C, Scarf VL, Ellwood DA, Oats JJN, Foureur MJ, et al. Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data. BMC Pregnancy Childbirth. 2014;14:206. doi: 10.1186/1471-2393-14-206. PubMed PMID: 24929250; PubMed Central PMCID: PMCPMC4067683. ## 32. Moudi Z, Tabatabaei SM. Birth outcomes in a tertiary teaching hospitals and local outposts: a novel approach to service delivery from Iran. Public Health. 2016;135:114-21. doi: 10.1016/j.puhe.2016.02.015. PubMed PMID: 27003671. ## 33. Moudi Z, Tabatabaie MG, Saeedi ZA, Vedadhir A. Predictors of decision making about childbirth setting in the southeast of Iran: home or hospital. Journal of Public Health. 2015;23(2):69-76. doi: 10.1007/s10389-015-0661-z. ## 34. Jouhki MR. Choosing homebirth--the women's perspective. Women Birth. 2012;25(4):e56-61. doi: 10.1016/j.wombi.2011.10.002. PubMed PMID: 22088677. ## 35. Neumeier M. Using Kotter’s change management theory and innovation diffusion theory in implementing an electronic medical record. Canadian Journal of Nursing Informatics. 2013;8:1-9## 36. Afsana K, Rashid SF. The challenges of meeting rural Bangladeshi women's needs in delivery care. Reprod Health Matters. 2001;9(18):79-89. doi: 10.1016/s0968-8080(01)90094-1. PubMed PMID: 11765404. ##