Determinants of institutional delivery among women in rural Haiti

In Haiti, 26% of deliveries are attended by a trained health professional. One in 93 Haitian women dies from child-birth complications. Historically this high rate of death has been attributed to delays in: 1) seeking care for obstetric emergencies, 2) reaching the closest health center and 3) receiving appropriate care on arrival. To evaluate the factors that increase institutional delivery in a specific rural area, Fond des Blancs, Haiti, we analyzed Maternal Child Health data from a household-based survey using a multi-stage sampling methodology. Among the sample of 650 women who had had a child in the five years preceding the survey, 49% had delivered at a heath facility (SE=2.1), higher than the national average. Multivariate analysis showed that mothers from this area were more likely to give birth in a hospital if they were young (15-24 years old) (OR=1.67, CI: 2.51 – 6.60), graduated from high school (OR=3.83, CI: 2.40 – 6.13), lived close to a hospital (OR=2.46, CI: 1.78 – 3.39), had four or more prenatal sessions (OR=10.71, CI: 4.42 – 25.96), transportation (OR=1.94, CI: 1.38 – 2.73) and risk signs during pregnancy (OR=1.68, CI: 1.11 – 2.53). This analysis shows that seeking care due to high risks, and distance from the hospital/access to transportation, in addition to the mother's age and education level, affect whether a woman gives birth at home or in a hospital. Uniquely, we show that the modifiable factor of prenatal care receipt can increase hospital delivery even in a rural district of Haiti.