School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines.
National Clinical Trials and Translation Center, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.
Womens Health (Lond). 2022 Jan-Dec;18:17455057221117957. doi: 10.1177/17455057221117957.
Women's choice of place of delivery has implications on maternal and child mortality. This study aims to provide an updated and detailed comparison of prevalence and determinants of home delivery in the Philippines, and in urban and rural communities.
Based on data from the 2017 Philippine National Demographic and Health Survey (NDHS), we estimated the prevalence of home delivery and determined factors influencing women's decision to deliver at home. Analyses were restricted to data from 7229 women who were cohabiting or married, and their last-born child using logistic regression methods for survey data.
There remain a considerable proportion of women aged 15-49 years old who delivered at home (17.92% (95% confidence interval (CI): 15.77, 20.30)). More women in rural areas delivered at home (23.53% (95% CI: 20.38, 26.99)) than their counterparts in urban areas (10.72% (95% CI: 8.23, 13.85)), reflecting a significant difference in the home delivery prevalence of women relative to their place of residence. Our regression analyses showed that there is a relatively greater effect observed for the rural population in most of the proximal factors considered including birth order, women's decision-making power, and emergency preparedness during pregnancy. Wealth index has the most pronounced effect with a significant increase in odds of home delivery among urban and rural women of the lowest wealth categories.
The use of institutional childbirth services remains suboptimal in the Philippines with significant disparities between urban and rural communities. Current strategies therefore need to adopt a multi-sectoral approach to address the complex factors influencing women's decision on place of delivery. Targeted efforts specific to population groups should also be made to contextualize and co-create health care services and solutions that will motivate them to deliver in health facilities.
妇女选择分娩地点会对母婴死亡率产生影响。本研究旨在提供菲律宾、城市和农村地区家庭分娩的流行率和决定因素的最新和详细比较。
基于 2017 年菲律宾全国人口与健康调查（NDHS）的数据，我们估计了家庭分娩的流行率，并确定了影响妇女选择在家分娩的因素。分析仅限于数据来自 7229 名同居或已婚的妇女及其最后出生的孩子，使用逻辑回归方法对调查数据进行分析。
仍有相当一部分 15-49 岁的妇女在家分娩（17.92%（95%置信区间（CI）：15.77，20.30））。农村地区的妇女在家分娩的比例（23.53%（95%CI：20.38，26.99））高于城市地区的妇女（10.72%（95%CI：8.23，13.85）），这反映了妇女相对于居住地的家庭分娩流行率存在显著差异。我们的回归分析表明，在所考虑的大多数近端因素中，农村人口的影响相对较大，包括出生顺序、妇女的决策权以及怀孕期间的应急准备。财富指数的影响最为明显，在城市和农村地区最贫穷的妇女中，家庭分娩的几率显著增加。
菲律宾利用机构分娩服务的情况仍不理想，城乡社区之间存在显著差异。因此，当前的战略需要采取多部门的方法来解决影响妇女分娩地点选择的复杂因素。还应针对特定人群组采取有针对性的努力，针对具体情况制定和共同创造医疗保健服务和解决方案，以激励他们在卫生设施中分娩。
