Rethinking birth preparedness interventions: Examining factors associated with use of institutional delivery in Guinea

The promotion of birth preparedness and complications readiness is conceptually compelling as a strategy for promoting access to skilled and emergency obstetric care; however, evaluations of such initiatives have yielded inconclusive evidence about their effectiveness.

A retrospective population-based survey was conducted in two regions of Guinea.  The study sample included 763 women with recent (within 24 months) births and explored their exposure to community- and facility-level interventions promoting birth preparedness and complication readiness among women with recent live births and stillbirths. 

Using multivariate regression models, we identified factors associated with women’s knowledge and practices related to birth preparedness, as well as their use of health facilities during childbirth.  We found that women’s knowledge about preparations for any birth (normal or complicated) was positively associated with increased preparation for birth (adjusted odds ratio 2.2, 95% CI 1.5, 3.2, p<0.001), which itself was associated with institutional delivery (adjusted odds ratio 2.5, 95% CI 1.7, 3.8, p<0.001).  In contrast, knowledge about complications readiness, including obstetric risks and danger signs, was not associated with birth preparation or with institutional delivery. Study findings suggest that women’s planning for and care-seeking during delivery may not be motivated by knowledge about risks. The study findings highlight the importance of focusing on preparation for all births—and not simply obstetric emergencies—in interventions aimed at increasing women’s use of skilled maternity care.