Prevalence of home birth among 880,345 women in 67 low- and middle-income countries: A meta-analysis of Demographic and Health Surveys

Abstract

Objective: The objective of this study was to determine the prevalence of home birth in low-middle income countries (LMIC) according to geographic area and sociodemographic characteristics between 2000 and 2019.

Methods: A meta-analysis was carried out using the most recent demographic and health surveys as a data source (total countries: 67). A random-effects meta-analysis was obtained to calculate pooled prevalence estimates of home birth for all the countries included and by geographic region of the world. Likewise, a subgroup analysis was performed to estimate the prevalence of home birth according to the sociodemographic factors considered for this study.

Results: The global prevalence of home birth was 28% (95% CI: 0.24-0.33), with the lowest prevalence in the region of Europe & Central Asia (5%, 95% CI: 0.03-0.07) and the highest in East Asia & Pacific region (38%, 95% CI: 0.26-0.51). Twelve countries had proportions of home births greater than 50% (seven belonged to the Sub-Saharan Africa region). The countries with the highest proportion of home births were Chad (78%), Ethiopia (73%), and Niger and Yemen (70% each). Concerning the wealth index, in general, the richest quintile (quintile 5) presented the lowest proportion of home births. In contrast, the poorest (quintile 1) generally had the highest prevalence of home births. Regarding educational level, women without education presented the highest proportions of home births in general. In relation to the area of residence, in almost all the countries studied, women in rural areas generally had a higher proportion of home births than those in urban areas.

Conclusions: Home births occurred in approximately 3 out of 10 women in LMIC. There are also differences in the proportion of home births according to socioeconomic factors such as educational level, wealth index, and rurality.

Keywords: Birth setting; Developing countries; Health surveys; Home childbirth; Meta-analysis.

Fig. 1

Map of 67 low-middle income countries included in the analysis. The map of the world is shown with the information of home delivery prevalence in a yellow-red gradient colour palette (n = 67). Countries, where no information was obtained, are shown in light green. The world map was constructed with the rnaturalearth and sf R packages. Source: DHS Program. . (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Forest plot of the meta-analysis of prevalence of home birth in 67 low-middle income countries. Countries are sorted in descending order of prevalence of home birth by region. Complex sampling design and weighting were considered in analyses. Pooled estimates are from random-effects meta-analyses.

Fig. 3

Prevalence of home birth according to (A) educational level, (B) wealth quintile, and (C) area of residence. Dumbbell plots of home delivery prevalence in 67 low- and middle-income Demographic and Health Survey countries by educational level (left), wealth quintile (middle), and area of residence (right). The country-level prevalence is plotted along the x-axis in colored circles next to the country average in the diamond shape. Countries are sorted in descending order by their average home delivery prevalence. The year of the survey is displayed in parentheses after the country name.