Prevalence and Determinants of Home Delivery among Women with Easy Access to Health Facilities in Sub-Saharan African Countries: A Multi-level Mixed Effect Analysis

Introduction: Most maternal deaths are associated with home deliveries, which account for half of births in low‑income countries. To develop appropriate policies and methods that could aid in addressing the issues, it is important to understand the burden of home delivery despite having easy access to health facilities in low‑income nations such as sub‑Saharan Africa. In addition, identifying and prioritizing determinants could help executives to review their perinatal policies. Therefore, this study aimed at assessing the prevalence and factors associated with home delivery among women who have access to health facilities.

Methods: A population‑based cross‑sectional study was done. The most recent Demographic and Health Survey (DHS) data from 22 sub‑Saharan African (SSA) countries from 2015 to 2022 were used. A total weighted samples of 493,396 women who gave birth at home despite having access to health facilities were included in the study. The data were examined using Stata 17. A multi‑level logistic regression model was used to identify factors associated with lactation–home delivery despite easy access to health facility. The adjusted odds ratio at the 95% confidence interval (Cl) was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p‑value of < 0.05 are declared statistically significant.

Results: The pooled prevalence of home delivery among women who had easy access to health facilities in 22 SSA countries was 23.67% (95% CI, 23.55–23.79). After adjusting for confounders, being above 35 years, being a rural resident, being from the poorest and lowest wealth quintile, and living in rural regions all increase the likelihood of home birth among women in sub‑Saharan Africa who have easy access to healthcare. Women with higher education, women who have optimal antenatal care (ANC) visits, women involved in healthcare decisions in households, and households with health insurance coverage reduce the odds of home delivery among women who have easy access to health facilities in sub‑Saharan Africa.

Conclusion: According to this study, a higher portion of women in sub‑Saharan Africa who had easy access to medical facilities gave birth at home. The study’s findings demonstrated that factors at the individual and community levels influence home delivery with easy access to health facilities. Policymakers, the government, health planners, and implementers must therefore understand the burden of the problem and should increase media coverage, enhance health insurance coverage, empower women, and mobilize resources for maternal care.