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Effect of maternal age on facility-based delivery: analysis of first-order births in 34 countries of sub-Saharan Africa using demographic and health survey data
Authors: Dunlop CL, Benova L, and Campbell O
Source: BMJ Open, 8(4):e020231. doi: 10.1136/bmjopen-2017-020231
Topic(s): Delivery care
Maternal health
Country: Africa
  Multiple African Countries
Published: APR 2018
Abstract: OBJECTIVES: Increasing access to skilled birth attendance, usually via childbirth in health facilities, is a key intervention to reduce maternal and perinatal mortality and morbidity. Yet, in some countries of sub-Saharan Africa, the uptake is <50%. Age and parity are determinants of facility-based delivery, but are strongly correlated in high fertility settings. This analysis assessed the independent effect of age on facility-based delivery by restricting to first-order births. It was hypothesised that older first-time mothers in this setting might have lower uptake of facility-based deliveries than women in the most common age groups for first birth. SETTING: The most recent Demographic and Health Surveys from 34 sub-Saharan African countries were used to assess women's delivery locations. PARTICIPANTS: 72?772 women having their first birth in the 5?years preceding the surveys were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Proportions and 95%?CIs of facility-based deliveries were estimated overall and by country. Multivariable logistic regression was used to calculate the odds of facility-based delivery for different maternal age groups (15-19, 20-24 and =25 years) for a pooled sample of all countries. RESULTS: 59.9% of women had a facility-based delivery for their first birth (95%?CI 58.6 to 61.2), ranging from 19.4% in Chad to 96.6% in Rwanda. Compared with women aged 15-19 years, the adjusted odds of having a facility-based delivery for those aged 20-24 was 1.4 (95% CI 1.3 to 1.5, p<0.001) and for those aged =25, 1.9 (95% CI 1.6 to 2.2, p<0.001). CONCLUSIONS: Older age at first birth was independently associated with significantly higher odds of facility-based delivery. This went against the hypothesis. Further mixed-method research is needed to explore how increased age improves uptake of facility-based delivery. Promoting facility-based delivery, while ensuring quality of care, should be prioritised to improve birth outcomes in sub-Saharan Africa. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. KEYWORDS: Africa South of the Sahara; delivery; demographic and health surveys; health facilities; maternal age; obstetric