Table 2 Maternal factors identified in relation to facility-based delivery rates in sub-Saharan Africa

Maternal age

Botswana; Burkina-Faso; Ghana; Ivory Coast; Kenya; Malawi; Nigeria; Tanzania; 21 countries in Africa

Younger women more likely to deliver in a facility, except if very young (<18 years of age); inconsistently found significant

[14–22]

Maternal education

Botswana; Burkina Faso; Eritrea; Ethiopia; Ghana; Ivory Coast; Kenya; Malawi; Namibia; Nigeria; Tanzania; Uganda; multiple low-income, developing or African nations

Greater education is linked to higher levels of facility based delivery and skilled birth attendance

[14, 16–21, 23–47]

Religion

Ethiopia; Ghana; Nigeria; Uganda

Those who practice traditional or Muslim religions in some countries are less likely to deliver in a facility, although finding is not universal

[14, 16, 35, 39, 40, 42, 48]

Ethnicity

Burkina Faso; Ghana; Kenya; Nigeria; Tanzania; Uganda

Ethnicity has an inconsistent relationship with FBD. In some settings ethnic minorities are more likely to seek FBD, in other settings ethnic minorities are less likely to seek FBD

[25, 27, 28, 31, 33, 40, 42, 49–51]

Region / province of residence

Ghana; Kenya; Rwanda; Tanzania; Uganda

Region, province of residence has an inconsistent relationship with FBD. In some nations there are strong regional and provincial differences, even after controlling for rural/urban status. In other nations, regional differences are largely explained by rural/urban or socioeconomic status

[16, 25, 34, 35, 40, 50, 52, 53]

Urban / Rural residence

45 developing countries; Botswana; Eritrea; Ethiopia; Ghana; Kenya; Mali; Namibia; Nigeria; Rwanda; Senegal; South Africa; Tanzania

Urban women more likely to deliver in a facility than rural women; however poverty is tightly linked to urban / rural status

[13, 14, 19, 25, 26, 31, 33–35, 39],[43, 46–48, 52, 54–56]

Wealth / SES / economic variables

31 countries in Africa; 45 developing countries; Botswana; Burkina Faso; Ghana; Kenya; Namibia; Nigeria; Rwanda; Tanzania; Uganda

Poorest women least likely to use delivery services; FBD seen as causing financial hardship; inequalities across wealth groups smallest in countries with highest female literacy rates

[13, 19, 26, 28–33, 35–37, 40, 42, 43],[47, 50, 52, 57]

Maternal employment (status / occupation)

Eritrea; Ethiopia; Ghana; Kenya; Nigeria; Zimbabwe

Maternal employment positively linked to FBD

[16, 28, 42, 46, 58]

Health insurance coverage

Ghana; Kenya; Mali; Nigeria; Rwanda; Senegal; Tanzania

Insurance coverage, fee exemptions linked to greater FBD rates; Membership in a voluntary community-based health insurance program was linked to increased FBD

[9, 17, 52, 56, 59, 60]

Parity / birth order

73 countries; Botswana; Burkina Faso; Ethiopia; Ghana; Ivory Coast; Kenya; Malawi; Nigeria; Tanzania

Higher parity, lower likelihood of FBD; No previous births linked to FBD; Birth order higher than 4, FBD less likely; Lower in the birth order, FBD more likely

[10, 14, 15, 17, 19, 20, 22, 25],[27–29, 31, 39, 42, 45, 50, 60, 61]

Marital status

Ethiopia; Kenya; Tanzania; Uganda; Zimbabwe

Marital status linked to FBD in some studies, not linked in others

[21, 24, 31, 39, 58]

Polygamous union

Ghana; Senegal

Less likely to have FBD

[35, 62]

Empowerment / Autonomy

31 countries in Africa; Eritrea; Ethiopia

Women with highest levels of empowerment most likely to seek FBD, have SBA; Other research suggests autonomy and wealth interact but autonomy alone is insufficient

[28, 32, 46]

Attitude toward importance of FBD / perceived need

48 developing countries; Nigeria; Tanzania

"Childbirth is natural" - no need for FBD; "FBD is important" linked to higher utilization

[15, 57, 60, 61, 63]

Attitude toward skills of doctor vs. TBA

Kenya; Tanzania

Perceived similarity of skilled vs unskilled attendants linked to lower FBD rates

[45, 61]

Embarrassment / fear of being shamed

Tanzania

Not having clean clothes for self or baby, embarrassment of poverty linked to lower FBD

[50]

Discussion with male partner on place of delivery

Tanzania

Discussion with male partner linked to higher FBD rates

[21]

Knowledge of pregnancy risk factors / safe delivery

Kenya; Tanzania

Greater knowledge linked to higher FBD rates

[21, 45]

Completion of a birth plan

Uganda

Completion of a birth plan linked to FBD

[24]

Concept of abnormal vs. normal pregnancy

Nigeria

"Normal" pregnancies mean home delivery is preferred

[63]

Having means of transport to facility / vouchers for transport

Ghana; Mali; Senegal; Uganda

No transport means FBD less likely

[8, 62, 64, 65]

Quality of previous delivery

Senegal

Poor quality previous delivery means less likelihood of FBD on subsequent deliveries

[62]

Location of previous delivery

Kenya; Uganda

Location of previous delivery predicts subsequent delivery location

[40, 45]

Pregnancy wantedness

Kenya

Desired pregnancies more likely to be delivered in facility

[25, 28, 30]

Birth complications / perceived problems

Tanzania; Zimbabwe

When problems arose, women reported desire to be in a facility; Complications during previous pregnancy predictive of FBD

[50, 58]

Use of herbal drugs in pregnancy

Nigeria

Use of herbal drugs associated with lower FBD rates

[42]

Desire to appear modern

Tanzania

Greater desire to appear modern linked to greater FBD

[50]

Fear of episiotomy

Swaziland

Fear of episiotomy linked to lower FBD

[66]

Precipitate Labor

Ghana; Swaziland

Decreased likelihood of FBD

[34, 66]

Use of maternity waiting homes

Zimbabwe

Increased likelihood of FBD

[58]