Identifying and understanding the factors associated with homebirths can contribute to improving maternal and child health and achieving the Sustainable Development Goals. The objective of this study was to conduct a comparative analysis of the factors associated with homebirths in Benin and Mali.
This study is based on the most recent data from the Demographic Health Surveys conducted in Mali and Benin in 2018. The dependent variable was homebirth, and the explanatory variables were the individual characteristics of the woman, distance to the health center, place of residence, number of prenatal consultations had, frequency of media exposure, and the use of the internet. The primary survey unit was considered in the analysis to measure the effect of context on the choice of place of delivery. Further, descriptive statistics and multilevel logistic regression analysis were used in the study.
Educational level was associated with homebirth in Benin and Mali; women with either no education or primary education are more likely to give birth at home. Women who did not live close to a health facility were more likely to give birth at home than those who did not face this problem in both countries. Not making visits for antenatal care (ANC) increases the odds of having a homebirth by 31.3 times [confidence interval (CI)=24.10–40.70] in Benin and 12.91 times (CI=10.21–16.33) in Mali. Similarly, women who went on 1–2 ANC visits were more likely to give birth at home compared with women who made 5 or more ANC visits in both countries. The number of children per woman was also a significant factor in both countries. Women who often or regularly paid attention to the media messages were less likely to give birth at home compared with those who did not follow relevant media inputs [adjusted odds ratio=0.42 (CI=0.26–0.67) in Benin and adjusted odds ratio=0.65 (CI=0.50–0.85) in Mali].
Increasing the demand and uptake of women’s health services by improving the availability and quality of services and establishing community health centers could help reduce the incidence of homebirths that can be risky and, thus, combat maternal and infant mortality.