Home delivery among women with adequate antenatal care: insights from a multilevel analysis of the 2019 Ethiopian mini demographic and health survey.

Abstract

Background: Despite Ethiopia's efforts to increase antenatal care (ANC) attendance, a significant number of women continue to deliver at home without skilled assistance, even after completing the recommended ANC visits. This study investigates the individual and community factors associated with home delivery among women who have received adequate ANC in Ethiopia.

Methods: Data from 1643 women in the 2019 Ethiopian Mini Demographic and Health Survey were analyzed. The study focused on women who completed adequate ANC visits for their most recent birth. Multivariable multilevel logistic regression was used to identify factors influencing home delivery, with adjusted odds ratios (AOR) and 95% confidence intervals (CI) for association strength.

Results: Home delivery prevalence among women with adequate ANC (≥ 4 visits) was 25.6% (95% CI: 23.55, 27.78). Community differences significantly contributed, as intra-cluster correlation dropped from 59 to 36.5% in the final model. Factors increasing the likelihood of home delivery included larger households (≥ 5 members) [AOR = 1.70; 95% CI: (1.09, 2.66)], poorest [AOR = 6.98; 95% CI: (2.89, 16.83)] and poorer wealth statuses [AOR = 2.77; 95% CI: (1.19, 6.45)], and 2-3 birth order [AOR = 2.48; 95% CI: (1.45, 4.21)]. Secondary education reduced home delivery risk [AOR = 0.37; 95% CI: (0.17, 0.80)]. Community-level factors included rural residence [AOR = 2.74; 95% CI: (1.19, 6.30)] and poor communities [AOR = 2.13; 95% CI: (1.03, 4.40)].

Conclusion: Socioeconomic disparities and rural settings contribute to home delivery prevalence. Policies should prioritize education, rural health infrastructure, and economic empowerment to address these gaps.