Spatial Distribution and Determinants of Home Delivery of Women in Rural Ethiopia

Maternal mortality remains a global public health issue, with 303,000 women dying each year due to childbirth-related complications. In Ethiopia, it is common practice for women to give birth without a healthcare professional’s assistance. This study’s objective is to investigate the spatial variation and factors associated with home delivery among reproductive-age women in rural Ethiopia.

The study used data from the Ethiopian Mini Demographic and Health Survey 2019. A weighted sample of 4160 reproductive-age women was employed in this study. For spatial analysis, Global Moran’s I and Getis-Ord Gi* analysis was used to detect the presence of clustering and hotspot areas of home delivery respectively. A multilevel logistic regression model was employed to identify factors associated with home delivery. An adjusted odds ratio with a corresponding 95% confidence interval and a p-value of < 0.05 were used to declare statistical significance.

The prevalence of home delivery in rural Ethiopia was 58.72% (95% CI: 57.20, 60.20). The spatial analysis showed the spatial disparities of home delivery across rural Ethiopia (global Moran’s I = 0.525, p-value=0.042). Getis-Ord Gi* analysis identified significant hotspot areas of home delivery in the Somali, Afar, Harari, and Dire Dawa regions. Rich wealth index (AOR = 0.392, 95% CI: 0.316, 0.487), secondary and above education (AOR = 0.297, 95% CI: 0.202, 0.438), household family size 7 and above (AOR= 2.279, 95% CI:1.643, 3.161), multiple births (AOR = 0.429, 95% CI: 0.269, 0.685), community poverty (AOR= 2.084, 95% CI:1.712,2.538) and community illiteracy (AOR= 2.232, 95% CI:1.864,2.674) were significant determinant factors for home delivery.

The proportion of home delivery in rural Ethiopia is still more than fifty percent and the study showed significant spatial disparities across the regions of Ethiopia. Mother’s educational level, parity, religion, family size, type of birth, wealth index, community poverty, and community illiteracy were found to be significant determinants of home delivery. Moreover, a health promotion strategy and public awareness to scale up education, and improving economic status are vital to reduce home delivery in the identified hotspot areas. Considering the finding that the education of women affects the place of delivery, the Ethiopian government with stakeholders should enhance initiatives to improve the educational status of women. Moreover, planners and policymakers should make further efforts to alleviate poverty at the household and community level.