Contextual influences on the use of health facilities for childbirth in Africa.
OBJECTIVE
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.
Stephenson
Rob
R
Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA. rbsteph@sph.emory.edu
Baschieri
Angela
A
Clements
Steve
S
Hennink
Monique
M
Madise
Nyovani
N
D000293:Adolescent; D000328:Adult; D000349:Africa; D002648:Child; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D036801:Parturition; D011247:Pregnancy; D012931:Social Environment; D012959:Socioeconomic Factors