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Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms

BACKGROUND: In Ghana, the site of this study, the maternal mortality ratio and under-five mortality rate remain high indicating the need to focus on maternal and child health programming. Ghana has high use of antenatal care (95%) but sub-optimum levels of institutional delivery (about 57%). Numerou...

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Autores principales: Speizer, Ilene S, Story, William T, Singh, Kavita
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247879/
https://www.ncbi.nlm.nih.gov/pubmed/25427853
http://dx.doi.org/10.1186/s12884-014-0398-7
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author Speizer, Ilene S
Story, William T
Singh, Kavita
author_facet Speizer, Ilene S
Story, William T
Singh, Kavita
author_sort Speizer, Ilene S
collection PubMed
description BACKGROUND: In Ghana, the site of this study, the maternal mortality ratio and under-five mortality rate remain high indicating the need to focus on maternal and child health programming. Ghana has high use of antenatal care (95%) but sub-optimum levels of institutional delivery (about 57%). Numerous barriers to institutional delivery exist including financial, physical, cognitive, organizational, and psychological and social. This study examines the psychological and social barriers to institutional delivery, namely women’s decision-making autonomy and their perceptions about social support for institutional delivery in their community. METHODS: This study uses cross-sectional data collected for the evaluation of the Maternal and Newborn Referrals Project of Project Fives Alive in Northern and Central districts of Ghana. In 2012 and 2013, a total of 2,527 women aged 15 to 49 were surveyed at baseline and midterm (half in 2012 and half in 2013). The analysis sample of 1,606 includes all women who had a birth three years prior to the survey date and who had no missing data. To determine the relationship between institutional delivery and the two key social barriers—women’s decision-making autonomy and community perceptions of institutional delivery—we used multi-level logistic regression models, including cross-level interactions between community-level attitudes and individual-level autonomy. All analyses control for the clustered survey design by including robust standard errors in Stata 13 statistical software. RESULTS: The findings show that women who are more autonomous and who perceive positive attitudes toward facility delivery (among women, men and mothers-in-law) were more likely to deliver in a facility. Moreover, the interactions between autonomy and community-level perceptions of institutional delivery among men and mothers-in-law were significant, such that the effect of decision-making autonomy is more important for women who live in communities that are less supportive of institutional delivery compared to communities that are more supportive. CONCLUSIONS: This study builds upon prior work by using indicators that provide a more direct assessment of perceived community norms and women’s decision-making autonomy. The findings lead to programmatic recommendations that go beyond individuals and engaging the broader network of people (husbands and mothers-in-law) that influence delivery behaviors.
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spelling pubmed-42478792014-12-01 Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms Speizer, Ilene S Story, William T Singh, Kavita BMC Pregnancy Childbirth Research Article BACKGROUND: In Ghana, the site of this study, the maternal mortality ratio and under-five mortality rate remain high indicating the need to focus on maternal and child health programming. Ghana has high use of antenatal care (95%) but sub-optimum levels of institutional delivery (about 57%). Numerous barriers to institutional delivery exist including financial, physical, cognitive, organizational, and psychological and social. This study examines the psychological and social barriers to institutional delivery, namely women’s decision-making autonomy and their perceptions about social support for institutional delivery in their community. METHODS: This study uses cross-sectional data collected for the evaluation of the Maternal and Newborn Referrals Project of Project Fives Alive in Northern and Central districts of Ghana. In 2012 and 2013, a total of 2,527 women aged 15 to 49 were surveyed at baseline and midterm (half in 2012 and half in 2013). The analysis sample of 1,606 includes all women who had a birth three years prior to the survey date and who had no missing data. To determine the relationship between institutional delivery and the two key social barriers—women’s decision-making autonomy and community perceptions of institutional delivery—we used multi-level logistic regression models, including cross-level interactions between community-level attitudes and individual-level autonomy. All analyses control for the clustered survey design by including robust standard errors in Stata 13 statistical software. RESULTS: The findings show that women who are more autonomous and who perceive positive attitudes toward facility delivery (among women, men and mothers-in-law) were more likely to deliver in a facility. Moreover, the interactions between autonomy and community-level perceptions of institutional delivery among men and mothers-in-law were significant, such that the effect of decision-making autonomy is more important for women who live in communities that are less supportive of institutional delivery compared to communities that are more supportive. CONCLUSIONS: This study builds upon prior work by using indicators that provide a more direct assessment of perceived community norms and women’s decision-making autonomy. The findings lead to programmatic recommendations that go beyond individuals and engaging the broader network of people (husbands and mothers-in-law) that influence delivery behaviors. BioMed Central 2014-11-27 /pmc/articles/PMC4247879/ /pubmed/25427853 http://dx.doi.org/10.1186/s12884-014-0398-7 Text en © Speizer et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Speizer, Ilene S
Story, William T
Singh, Kavita
Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms
title Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms
title_full Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms
title_fullStr Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms
title_full_unstemmed Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms
title_short Factors associated with institutional delivery in Ghana: the role of decision-making autonomy and community norms
title_sort factors associated with institutional delivery in ghana: the role of decision-making autonomy and community norms
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247879/
https://www.ncbi.nlm.nih.gov/pubmed/25427853
http://dx.doi.org/10.1186/s12884-014-0398-7
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