title: Contextual influences on the use of health facilities for childbirth in Africa.
abstract: 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.
authors.affiliation: Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA. rbsteph@sph.emory.edu
authors.forename: Rob
authors.initials: R
authors.lastname: Stephenson
authors.forename: Angela
authors.initials: A
authors.lastname: Baschieri
authors.forename: Steve
authors.initials: S
authors.lastname: Clements
authors.forename: Monique
authors.initials: M
authors.lastname: Hennink
authors.forename: Nyovani
authors.initials: N
authors.lastname: Madise
mesh_terms: 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