Prevalence and Determinants of Home Delivery in Urban and Rural Philippines: Evidence From the 2017 National Demographic and Health Survey

Abstract Background: Women’s choice of place of delivery has implications on rates of maternal and child mortality. Despite notable efforts to improve maternal health in the Philippines, disparities in the utilization of health services during pregnancy and delivery persist between urban and rural communities. This study aims to provide an updated and detailed comparison of prevalence and determinants of home delivery in the Philippines, and in urban and rural communities in the country. Methods: We used data from the 2017 Philippine National Demographic and Health Survey (NDHS). A total of 3,084 married or cohabiting women 15 to 49 years old with one birth in the preceding year of the survey were included in the analyses. Logistic regression methods for survey data were used to identify determinants for the choice of home-based childbirth over institutional delivery in the Philippines, and in urban and rural communities. Results: There remains a considerable proportion of 3,084 married or cohabiting women aged 15 to 49 years old with one birth in the preceding year of the survey who delivered at home [18.97% (95% CI: 16.04, 22.28)]. More women in rural areas delivered at home [22.95% (95% CI: 18.93, 27.54)] than their counterparts in urban areas [13.49% (95% CI: 9.59, 18.66)], reflecting a significant difference in the home delivery prevalence of women relative to their place of residence. Our regression analyses for all three populations consistently showed that socio-economic, individual, and pregnancy-related factors influence a mother’s decision to deliver at home. Wealth index has the most pronounced effect with a significant increase in odds of home delivery among urban and rural women of the lowest wealth categories.Conclusions: There are marked improvements in reducing maternal and child mortality in the Philippines, reflecting progress in health care services. However, our findings suggest that current strategies need to be revisited to substantially reduce preventable deaths associated with childbirth, particularly in the context of birthing location, and narrow the gap between urban and rural women. Innovative interventions targeting women with specific characteristics as reported in our study are needed. Efforts should also be made to contextualize and co-create innovations and solutions that will motivate women to deliver in health facilities.