Prevalence and determinants of home delivery among pregnant women in Somaliland: Insights from SLDHS 2020 data

Abstract

Objective

This cross-sectional study aimed to identify the determinants of home deliveries among women in Somaliland, with the objective of informing targeted interventions to improve maternal and child health outcomes.

Design

A cross-sectional study design was employed, utilizing data from a nationally representative sample of 3250 women in Somaliland. A multivariate logistic regression analysis was conducted to examine the factors influencing the likelihood of home delivery.

Site

The study was conducted in Somaliland, a region where home delivery remains prevalent.

Participants

The study included 3250 women of reproductive age in Somaliland who had given birth.

Interventions

No specific interventions were administered as part of this study. The focus was on understanding the factors associated with home deliveries.

Main measurements

Sociodemographic, economic, and regional factors were examined as potential determinants of home deliveries. Education levels of women and their husbands, maternal age at first marriage and first birth, and household wealth were among the main measurements analyzed.

Results

The analysis revealed that higher education levels were associated with a decreased likelihood of home delivery. Women with secondary (OR: 0.42, 95% CI: 0.32–0.55) or higher (OR: 0.21, 95% CI: 0.12–0.37) education were less likely to deliver at home than those with no education. Similarly, women whose husbands had a secondary (OR: 0.55, 95% CI: 0.41–0.73) or higher (OR: 0.43, 95% CI: 0.28–0.66) education were less likely to deliver at home. Increased maternal age at first marriage (OR: 1.04, 95% CI: 1.02–1.06) and first birth (OR: 1.03, 95% CI: 1.01–1.05) were significant predictors of home delivery. Lower household wealth was also associated with a higher likelihood of home delivery. Significant regional variations were observed, with certain regions showing higher rates of home deliveries compared to others.

Conclusions

The findings highlight the importance of targeted interventions to address sociodemographic and regional disparities in the utilization of institutional delivery services in Somaliland. Strategies should focus on improving access to and quality of maternal healthcare services, empowering women's decision-making, and engaging men to address gender norms within households.