The choice of place of delivery by pregnant women is usually an important decision at the final stage of their gestational period. Some of these pregnant women deliver at home, whereas some go to the health facility. Despite the numerous interventions by the WHO and programmes implemented by various governments of Liberia, home delivery remains one of the significant challenges the country faces. The current study revealed that more than 90% of the women studied delivered at home in their most recent delivery in Margibi County.
The high prevalence rate recorded is consistent with the findings of a study conducted in Zala Woreda, southern Ethiopia, where 77% of the women studied reported delivering at home in their most recent delivery 24. In a similar study conducted in Dodota district of Northwest Ethiopia, almost 80% of the women studied reported delivering at home 25. The high prevalence of home delivery among pregnant women is further substantiated by another study conducted in Akure, Nigeria, where 81.8% of women studied mentioned delivering at home in their most recent delivery 26. However, in Mukono District-Uganda and Jimma Zone, Southwest Ethiopia, the prevalence level of home delivery was less than 35% 23,27. Unlike these studies, our study considered women who delivered within one year prior to the study as our inclusion criteria. This could have accounted for the inconsistency in the prevalence level recorded.
The high prevalence of home delivery could be a possible cause of the low vaccine uptake in the County exposing neonates to infectious diseases. The Government of Liberia, in tackling the low vaccine uptake and high infant mortality, should focus more resources into increasing institutional deliveries.
The factors associated with home delivery among pregnant women in the country were age, parity, attitude of health workers, the season of the year, rapid onset of labour and availability of transport.
Women who had given birth more than once had increased odds of home delivery compared to women who gave birth for the first time. This finding is similar to the findings of other studies done in Southwest Ethiopia, Trincomalee, Sri Lanka and Nepal 23,28,29. This might be because women who have given birth several times perceive themselves to be more experienced in labour, thereby developing more interest in using home delivery services 30,31.
The attitude of health workers towards clients who access health care services is instrumental to the care-seeking participation rate. Pregnant women who perceive health workers to be of good attitude were more likely to deliver at a health facility. This finding corroborates the findings of a study conducted in Uganda, where women who rated health workers attitudes as poor had 5.4 times increased odds of home delivery. Similarly, in a survey conducted in Bahirdar, Ethiopia, pregnant women who rated health workers attitudes as poor had 4.4 times increased odds of home delivery compared to their counterparts. In Sekela district of West Ethiopia, in a study involving women, the odds of home delivery was 6.0 times increased among those who perceive health workers to be of poor attitude compared to those who perceive them to be of good attitude 28,30,32,33. Resources should be channeled into attitude training of these health workers and supportive supervision to ensure they act accordingly.
Our study further revealed that the period of the year in which the women give birth was a significant predictor of home delivery. Women who delivered during the rainy season had an increased odds of home delivery compared to those who delivered during the dry season. This is so because most of these women are rural dwellers with poor road networks connecting them to the health facilities. Because of this poor road network, health facility accessibility in the rainy season becomes difficult compared to the dry season which could have accounted for the high rate of home delivery during the rainy season. This study corroborates the results of a study conducted in rural Mozambique where they detected the predicted association between season of birth and the likelihood of home delivery.
The problem of recall bias was a limitation in this study. Women were required to recall their past experiences in their last childbirth which could be as long as 12 months prior to the survey. Research assistants reviewed the women ANC cards to support their responses to curtail this limitation.