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

From: Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review

Maternal factor Country in which it was studied Direction of influence Cites
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 [1422]
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, 1621, 2347]
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, 4951]
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, 3335, 39],[43, 4648, 52, 5456]
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, 2833, 3537, 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],[2729, 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]