Factors associated with choice of home birth as place of delivery among women of reproductive age in South Africa

Abstract

A growing prevalence of home births has been reported, yet factors predicting this prevalence have not been adequately investigated in South Africa. Using the 2016 South Africa Demographic and Health Survey dataset, this study aimed to examine the factors associated with the choice of birth at home as the place of delivery among women of reproductive age in South Africa. A total of 2862 women (aged 15–49 years) who gave birth within five years preceding the survey were included in the analysis. Both univariate and multivariable regression analyses were used to determine the predictors for the choice of home birth. The prevalence of births in health facilities and home childbirths were 96.0% and 4.0%, with the majority in non-urban areas, and in Limpopo, KwaZulu-Natal and Eastern Cape Provinces (≥ 11.4%). After adjusting for confounders, the factors associated with the choice of place of delivery were: primary education [AOR = 1.97; p < 0.001], secondary/higher education [AOR = 3.51; p > 0.05]); cohabitation [AOR = 1.88; p < 0.01]; and parity 4–6 [COR = 2.59; p < 0.001], parity 7⁺ [AOR = 5.41; p < 0.001]. Predictors for choice of home birth as a place of delivery included increased educational attainment, cohabitation, higher parity and non-urban place of residence. Innovative strategies reinforcing polices or behaviours aimed at women of reproductive age with the aforementioned demographic indicators are needed to increase the use of healthcare facilities for childbirth, thereby reducing maternal and neonatal mortality, especially in non-urban provinces of South Africa.