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Socioeconomic factors associated with choice of delivery place among mothers: a population-based cross-sectional study in Guinea-Bissau
  1. Sanni Yaya1,
  2. Ghose Bishwajit1,
  3. Nathali Gunawardena2
  1. 1School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
  2. 2Faculty of Science, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Sanni Yaya; sanni.yaya{at}


Background Maternal death outcome remains high in Guinea-Bissau. Delivery-related complications and maternal mortality could be prevented by increasing women’s access to skilled pregnancy care. Socioeconomic status (SES) is often associated with low health service utilisation in low/middle-income countries. In Guinea-Bissau, little is known on the relationship between SES and use of health facility for delivery. In this study, we examined the association between women’s choice of health facility delivery with their SES.

Methods Current data from Multiple Indicator Cluster Survey conducted in Guinea-Bissau, 2014 were used in this study. The place of delivery (home or health facility) was the outcome variable of interest using 7532 women of reproductive age (15–49 years). Respondents’ characteristics were described by summary statistics, while multivariable logistic regression model was used to examine the association of demographic and socioeconomic characteristics on facility-based delivery. Adjusted ORs, 95% CIs and p values were computed to identify significant determinants.

Results Results show that in proportion of women delivering at home was higher than of delivery at a health facility. Overall percentage of women who delivered at health facility was 39.8%, with the rate being substantially higher among urban (67.8%) compared with their rural (30.2%) counterparts. Percentage of delivering at home was highest in Oio region (23.8%) and that of delivery at a health facility was highest in the Sector Autónomo de Bissau region (18.7%). In the multivariable analysis, women in urban areas compared those who had no education, those who had primary and secondary/higher level of education were 2.2 and 3.3 times more likely to deliver at a health facility. The odds of facility were also highest among the women from the richest households, 5.3 and 5 times among urban and rural women, respectively.

Conclusion Based on these findings, the study concludes that the percentage of health facility delivery is low in Guinea-Bissau, which can be promoted through scaling up women’s SES. The findings could guide healthcare policy-makers to address the issue of unskilled delivery services and increase the use of facility-based delivery particularly among the disadvantaged women.

  • facility delivery
  • global health
  • antenatal care
  • guinea bissau
  • maternal healthcare
  • institutional delivery
  • women of reproductive age

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • SY and GB contributed equally.

  • Handling editor Seye Abimbola

  • Contributors SY and GB contributed to the study design, the review of literature and analysis of literature, manuscript conceptualisation, preparation and data analysis. NG contributed to the literature review. SY had final responsibility to submit for publication. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval MICS surveys are approved by Unicef ethical board and the study country. The dataset is available in the public domain in anonymised form; therefore, no further approval was necessary.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data for this study were sourced from Multiple Indicator Cluster Survey:

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