Determinants of Utilization of Institutional Delivery Services in Zambia: An Analytical Cross-sectional Study

Abstract Introduction Institutional delivery at birth is an important indicator of improvements in maternal health, which remains one of the targets of sustainable development goals intended to reduce the maternal mortality ratio. Despite the importance of delivering at institutions with skilled attendants, approximately 15% of women prefer to give birth at home, according to the 2018 Zambia Demographic and Health Survey (ZDHS). Therefore, the aim of the present study was to identify determinants of utilization of institutional delivery in Zambia. Methods A population based cross-sectional study design was used to examine 9841 women between 15 and 49 years of age from the 2018 ZDHS. Both descriptive and inferential statistics were used. Logistic regression was applied to calculate crude odds ratio (OR), adjusted OR, 95% confidence interval (CI). The level of significance was set at p ≤ 0.05 for all analyses. Results The proportions of institutional and home delivery were 93.6% and 6.2%, respectively, in urban areas. The corresponding figures were 80.2% and 19.8% in rural areas. Sociodemographic factors – woman’s (OR 1.76; 95% CI: 1.04–2.99) and husband’s secondary/higher education (OR 1.83; 95% CI: 1.09–3.05), higher wealth index (OR 2.31; 95% CI: 1.27–4.22) and rural place of residence (OR 0.55; 95% CI: 0.30–0.98) – were significantly associated with institutional delivery. Healthcare-related factors – 5-12 visits to antenatal care (ANC) (OR 2.33; 95% CI: 1.66–3.26), measuring blood pressure (OR 1.65; 95% CI: 1.02–2.66) and testing blood samples (OR 2.01; 95% CI: 1.04s–3.88) during pregnancy – were found to be significantly associated with institutional delivery. Conclusions The present study shows that sociodemographic factors such as women’s and husband’s secondary or higher education, higher wealth index, place of residence as well as healthcare-related factors such as 5-12 ANC visits, measuring blood pressure and testing blood samples during pregnancy were found to be significantly associated with institutional delivery. To improve institutional delivery and reduce maternal and newborn mortality, policymakers and public health planners should design an effective intervention program targeting these factors.