title: Determinants of institutional delivery among women of childbearing age in rural Haiti.
abstract: Institutional delivery is an important factor associated with reduced maternal mortality rate (MMR). MMR in Haiti is high (350 per 100,000) and institutional delivery is low-just over 25 % of women delivered at a health facility in 2010. There also exists substantial rural-urban disparity in delivery with more hospital deliveries in urban than in rural areas. We aimed to study the prevalence and determinants of institutional delivery in a sample of women of childbearing age in rural Haiti. The study took place in Fond des Blancs and Villa, as part of a baseline assessment undertaken prior to implementation of a maternal, child health, nutrition, and water and sanitation program. From October to November 2011, women 15-49 years old (N = 575) were selected using a cross-sectional two-stage sampling strategy. We used descriptive and multivariate logistic regression analyses to assess the prevalence of and factors associated with institutional delivery. The prevalence of institutional delivery was 45.4 %; a rate higher than the national average of 25 %. In adjusted analyses, correlates of institutional delivery were younger maternal age (25 years and younger) (OR 1.82; CI 1.15, 2.90; P = 0.0112), antenatal care receipt (OR 3.70; CI 1.84, 7.43; P = 0.0003) and those who were poor according to our poverty index score classification (OR 2.04; CI 1.13, 3.69; P = 0.0187). This study shows that increased hospital delivery is likely explained by accessibility to antenatal care. Programs that improve access to antenatal care, with concurrent efforts to address structural inequalities that drive socio-economic deprivation, are likely critical to increasing institutional delivery.
authors.affiliation: Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA, nseraphin@ufl.edu.
authors.forename: Marie Nancy
authors.initials: MN
authors.lastname: Séraphin
authors.forename: Ismael
authors.initials: I
authors.lastname: Ngnie-Teta
authors.forename: Mohamed Ag
authors.initials: MA
authors.lastname: Ayoya
authors.forename: Maria R
authors.initials: MR
authors.lastname: Khan
authors.forename: Catherine W
authors.initials: CW
authors.lastname: Striley
authors.forename: Ellen
authors.initials: E
authors.lastname: Boldon
authors.forename: Aissa
authors.initials: A
authors.lastname: Mamadoultaibou
authors.forename: Jean Ernst
authors.initials: JE
authors.lastname: Saint-Fleur
authors.forename: Leslie
authors.initials: L
authors.lastname: Koo
authors.forename: Miliane
authors.initials: M
authors.lastname: Clermont
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006205:Haiti; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D017533:Marital Status; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data; D011295:Prenatal Care / Q000706:statistics & numerical data; D055815:Young Adult