Institutional Delivery and Satisfaction among Indigenous and Poor Women in Guatemala, Mexico, and Panama.
Indigenous women in Mesoamerica experience disproportionately high maternal mortality rates and are less likely to have institutional deliveries. Identifying correlates of institutional delivery, and satisfaction with institutional deliveries, may help improve facility utilization and health outcomes in this population. We used baseline surveys from the Salud Mesoamérica Initiative to analyze data from 10,895 indigenous and non-indigenous women in Guatemala and Mexico (Chiapas State) and indigenous women in Panama. We created multivariable Poisson regression models for indigenous (Guatemala, Mexico, Panama) and non-indigenous (Guatemala, Mexico) women to identify correlates of institutional delivery and satisfaction. Compared to their non-indigenous peers, indigenous women were substantially less likely to have an institutional delivery (15.2% vs. 41.5% in Guatemala (P<0.001), 29.1% vs. 73.9% in Mexico (P<0.001), and 70.3% among indigenous Panamanian women). Indigenous women who had at least one antenatal care visit were more than 90% more likely to have an institutional delivery (adjusted risk ratio (aRR) = 1.94, 95% confidence interval (CI): 1.44-2.61), compared to those who had no visits. Indigenous women who were advised to give birth in a health facility (aRR = 1.46, 95% CI: 1.18-1.81), primiparous (aRR = 1.44, 95% CI: 1.24-1.68), informed that she should have a Caesarean section (aRR = 1.41, 95% CI: 1.21-1.63), and had a secondary or higher level of education (aRR = 1.36, 95% CI: 1.04-1.79) also had substantially higher likelihoods of institutional delivery. Satisfaction among indigenous women was associated with being able to be accompanied by a community health worker (aRR = 1.15, 95% CI: 1.05-1.26) and facility staff speaking an indigenous language (aRR = 1.10, 95% CI: 1.02-1.19). Additional effort should be exerted to increase utilization of birthing facilities by indigenous and poor women in the region. Improving access to antenatal care and opportunities for higher-level education may increase institutional delivery rates, and providing culturally adapted services may improve satisfaction.
Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America.
Danny V
0000-0002-5237-1300
DV
Colombara
Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America.
Bernardo
B
Hernández
Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America.
Alexandra
A
Schaefer
Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America.
Nicholas
N
Zyznieuski
Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America.
Miranda F
MF
Bryant
Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America.
Sima S
SS
Desai
Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America.
Marielle C
MC
Gagnier
Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America.
Casey K
CK
Johanns
Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America.
Claire R
CR
McNellan
Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America.
Erin B
EB
Palmisano
Salud Mesoamérica Initiative, Inter-American Development Bank, Calle 50 con Calle Elvira Méndez, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá City, Panamá
Diego
D
Ríos-Zertuche
Salud Mesoamérica Initiative, Inter-American Development Bank, Calle 50 con Calle Elvira Méndez, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá City, Panamá
Paola
P
Zúñiga-Brenes
Salud Mesoamérica Initiative, Inter-American Development Bank, Calle 50 con Calle Elvira Méndez, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá City, Panamá
Emma
E
Iriarte
Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America.
Ali H
AH
Mokdad
D000293:Adolescent; D000328:Adult; D003144:Communication Barriers; D036861:Delivery, Obstetric / Q000401:mortality* / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006166:Guatemala; D006268:Health Facilities / Q000941:ethics / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000941:ethics* / Q000706:statistics & numerical data; D006303:Health Services, Indigenous / Q000941:ethics / Q000458:organization & administration*; D006801:Humans; D007199:Indians, South American; D008428:Maternal Mortality / Q000208:ethnology / Q000639:trends; D008800:Mexico; D008875:Middle Aged; D010176:Panama; D010298:Parity; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D010549:Personal Satisfaction; D011203:Poverty / Q000208:ethnology / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000941:ethics / Q000706:statistics & numerical data