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AJPH First Look, published online ahead of print Nov 29, 2005
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January 2006, Vol 96, No. 1 | American Journal of Public Health 84-93
© 2006 American Public Health Association
DOI: 10.2105/AJPH.2004.057422

PUBLIC HEALTH MATTERS

Contextual Influences on the Use of Health Facilities for Childbirth in Africa

Rob Stephenson, PhD, Angela Baschieri, MSc, Steve Clements, PhD, Monique Hennink, PhD and Nyovani Madise, PhD

Rob Stephenson is with the Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Ga. Angela Baschieri, Steve Clements, and Monique Hennink are with the Opportunities and Choices Reproductive Health Research Programme, Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, England. Nyovani Madise is with the African Population and Health Research Center, Nairobi, Kenya.

Correspondence: Requests for reprints should be sent to Rob Stephenson, PhD, Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 (e-mail: rbsteph{at}sph.emory.edu).

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.






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