The 130th Annual Meeting of APHA

4289.0: Tuesday, November 12, 2002 - Board 5

Abstract #49240

Why do women choose to deliver at home and not in a hospital? The Guatemala case study

Fannie Fonseca-Becker, DrPH, MPH, Center for Communication Programs, Bloomberg School of Public Health, Johns Hopkins University, 111 Market Place, Suite 310, Baltimore, MD 21202 and Irina Zablotska, MD, MPH, Department of Population and FHS, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe St., 4th floor, Baltimore, MD 21202, 410-659-6300,

Background: Maternal mortality in Guatemala is one of the highest in Latin America with approximately 190 maternal deaths per 100,000 live births. The majority of mothers deliver at home with the support of a traditional birth attendant, or of some family member. The objective of this study is to investigate how previous experience with health services and ideational factors (knowledge of danger symptoms, attitudes towards health sector, perceptions and freedom to seek and exchange information) are associated with institutional delivery.

Methods: Data on 1008 women 15-45 years of age were collected by a cross-sectional probability sample in the Altiplano region. We utilized model building with regression techniques to identify predictors influencing women's choice of place of delivery.

Results:. Women with positive attitudes towards the health sector were 2.19 times more likely to deliver in a hospital (CI 1.52-3.16). Perceived freedom to seek services and information were also significantly associated with hospital delivery. Socio-demographic characteristics such as low education, high parity, being Mayan and rural residence were significant constraints to institutional delivery.

Conclusion: Ideational factors and socio-demographic characteristics are significant predictors of whether a woman will deliver or not in a hospital setting. Addressing these factors in programs to improve maternal survival is especially important in countries with high maternal mortality.

Learning Objectives: At the conclusion of this session the participants in this session will be able to

Keywords: Access and Services, Barriers to Care

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Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Maternal Health: International Perspectives

The 130th Annual Meeting of APHA