While high-quality skilled birth attendance in facilities can avert maternal and neonatal morbidity and mortality, about 60% of births in the Sierra Madre region occur at home. Compañeros En Salud (CES), Partners In Health’s affiliate in Mexico, works to strengthen health care delivery in 10 rural communities and a hospital-birth center (HBCAAC/Casa Materna) in Chiapas.

Methods:

Through retrospective analysis of the CES Maternal Health Census, the proportion of women who delivered in HBCAAC/Casa Materna were compared between August 2016-July 2017 and August 2017-July 2018 using a 2-sample test for equality of proportions. Surveys about CES resource utilization and barriers to facility-based delivery were conducted with women living in the 5 CES-affiliated communities closest to HBCAAC/Casa Materna but delivered between January 2017-July 2018 elsewhere.

Results:

In August 2016-July 2017, 33.7% (111/329) of women living in CES catchment areas delivered at HBCAAC/Casa Materna. Despite CES resources (gasoline vouchers, food vouchers, accommodation) to facilitate facility-based delivery, this rate minimally increased to 38.2% (128/335) from August 2017-July 2018 (p=0.26). Among survey respondents, 84.5% (49/58) reported awareness of aforementioned resources, but 69.0% (40/58) reported home births--main reasons for which included lack of desire or necessity of facility-based delivery, increased trust in traditional midwives, not enough time to get to HBCAAC/Casa Materna, and cost.

Conclusions:

Our findings suggest that understanding modifiable barriers is crucial to increasing access to high-quality childbirth care and will guide the maternal health team in modifying resources to better meet the needs of women in Chiapas.