Contextual influences on the use of health facilities for childbirth in Africa

Am J Public Health. 2006 Jan;96(1):84-93. doi: 10.2105/AJPH.2004.057422. Epub 2005 Nov 29.


Objectives: Previous studies of maternal health-seeking behavior focused on individual- and household-level factors. We examined community-level influences on the decision to deliver a child in a health facility across 6 African countries.

Methods: Demographic and Health Survey data were linked with contextual data, and multilevel models were fitted to identify the determinants of childbirth in a health facility in the 6 countries.

Results: We found strong community-level influences on a woman's decision to deliver her child in a health facility. Several pathways of influence between the community and individual were identified.

Conclusions: Community economic development, the climate of female autonomy, service provision, and fertility preferences all exert an influence on a woman's decision to seek care during labor, but significant community variation remains unexplained.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Africa
  • Child
  • Female
  • Health Facilities / statistics & numerical data*
  • Health Services Accessibility*
  • Humans
  • Infant, Newborn
  • Maternal Health Services / statistics & numerical data*
  • Middle Aged
  • Parturition*
  • Pregnancy
  • Social Environment*
  • Socioeconomic Factors