Introduction: In Ethiopia, despite existent intensive efforts to improve maternal health, the proportion of births delivered at home remains high and is still the top priority among the national health threats. The study aimed to examine effects of individual and community-level factors in women’s decision to deliver at home versus in a health facility.
Methods: Data for this study were obtained from the nationally representative 2011 Ethiopia Demographic and Health Survey (EDHS 2011) and focused on a sample from 576 communities of 7,908 women whose most recent births were within five years preceding the survey. The data were analyzed using a two level-mixed-effects logistic regression model to determine the individual and community-level factors associated with place of delivery.
Results: In Ethiopia, 88% of deliveries took place at home. Both individual and community-level factors were associated with women’s choice
for place of delivery. Lower educational levels of mothers (OR=2.74; 95% CI: 1.84, 4.70) and their husbands (OR=2.31; 95% CI: 1.68, 3.18) were both positively associated with the odds of giving birth at home. The net odds of home delivery among mothers without antenatal care (ANC) visits for their recent pregnancy was 3.7 times higher than among mothers who made the recommended four or more ANC visits (OR=3.72; 95% CI: 2.85, 4.83). Non-exposure to radio or television messages (OR=1.51; 95% CI: 1.13, 2.01), parity of six or more births, (OR=2.68, 95% CI: 1.96, 3.68) and
perceived problems reaching health facilities due to distance (OR=1.29, 95% CI: 1.03, 1.62) were positively associated with home birth. With regard to the community-level characteristics, rural communities (OR=4.67, 95% CI: 3.06, 7.11), pastoralist communities (OR=4.53, 95% CI:
2.81, 7.28), communities with higher poverty levels (OR=1.49; 95% CI: 1.08, 2.22), and those with lower ANC utilization (OR=2.01, 95% CI:
1.42, 2.85) and women in areas with perceived problem of distance to health facilities (OR=1.29; 95% CI: 1.03, 1.62) had a positive influence
on women to give birth at home.
Conclusion: Not only individual characteristics of the women but also community-level factors determine women’s decision to deliver at home. Thus efforts to decrease the proportion of births delivered at home in Ethiopia should focus both on individuals and on communities.