Factors Associated with Place of Birth Among Ethiopian Orthodox Christian Women in North Gondar, Ethiopia

Abstract

Despite reductions in maternal mortality over the past decade in Ethiopia, at 412 deaths per 100,000 live births as of 2016, maternal deaths remain well above levels targeted by the Sustainable Development Goals.1,2 There is strong evidence that antenatal care and giving birth at a facility substantially lower the risk of maternal mortality.1 The purpose of this study was to identify factors associated with facility birth among Ethiopian Orthodox Christian women in the North Gondar region of Ethiopia. This was a cross sectional study of 287 women of reproductive age (15-49 years). A comprehensive survey was administered, which assessed sociodemographic factors, obstetric history, and religious activity. Descriptive and inferential analysis were performed and prevalence ratios (PR) and Wald test statistics were calculated along with 95% confidence intervals. Facility delivery was more common for first and most recent birth among women with higher levels of education (>8 years) (first birth: PR=8.16; 95%CI 3.82-17.4) (recent birth: PR=2.79; 95%CI 2.09, 3.74), younger women (16-24 years) (first birth: PR=8.16; 95%CI 3.82-17.4) (recent birth: PR=2.79; 95%CI 2.09-3.74), women living in urban towns (first birth: PR=2.93; 95%CI 1.33-6.46) (recent birth: PR=1.67; 95%CI 1.05, 2.65), women who received antenatal care (first birth: PR=8.36; 95%CI 2.11-33.05) (recent birth: PR=3.81; 95%CI 1.78-8.14), gave birth for the first time after the age of 18 (first birth: PR=4.35; 95%CI 2.07-9.15) (recent birth: PR=1.74; 95%CI 1.15-2.63), and women who valued medical expertise (first birth: PR=9.6; 95%CI 2.42-38.00) (recent birth: PR=4.54; 95%CI 1.21-16.95). History of facility delivery was more common among women who received frequent advice and support from their spouse (PR=2.78; 95%CI 1.48-5.22) and health workers (PR=5.90; 95%CI 2.57-13.57). Facility delivery at most recent birth was less common among women who valued cultural traditions (PR=0.63; 95%CI 0.43-0.91) and delivered at home for their first birth (PR=0.37; 95%CI 0.28-0.49). History of ever delivering at a facility was less common among women who perceived home delivery as safe (PR=0.24; 95%CI 0.13-0.44) and comfortable (PR=0.29; 95%CI 0.18-0.48. These results reinforce existing research and provide valuable information specific to the Ethiopian Orthodox Christian population that could inform future interventions to increase facility delivery.