Why Women in Ethiopia Give Birth at Home? A Systematic Review of Literature

Figures & data

Table 1 Inclusion and Exclusion Criteria for Articles Selected for This Review

	Inclusion	Exclusion
Population	• Women who gave birth during the last five years	• Population that exclusively included women who gave birth at facilities
Outcome	• Place of birth (home verse facilities) • Factors significantly associated preference of homebirth • Reasons for preference of homebirth	• Post-natal services • Predictors of facility births • Post-natal services among home delivered mothers
Study designs	• Original quantitative studies identifying factors associated with homebirth, and identifying reasons for choosing homebirth: cross-sectional studies, cohorts,	• Qualitative studies (missed the two objectives of this review) • RCTs • Mixed methods
Publication status	• Published on peer-reviewed journals • Published from 2010 on wards	• Published before 2010 • Not found on peer-reviewed journals
Place of studies	• Within Ethiopia	• Other countries

Box 1 Review Search Terms

A	B
Home birth related terms	Outcome-related terms
Homebirth OR home birth	Factors associated + HB*
Home childbirth OR childbirth	Predicting factors +HB*
Childbirth at home	Factors significantly associated +HB*
Out-of-hospital birth	Reasons of + HB**
Out-of-hospital-childbirth	Why women choose + HB**
	Determinant factors + HB*
	Determining factors + HB*

Notes: HB= Homebirth OR home birth OR Childbirth at home OR out-of-hospital childbirth. *Specific objective 1 of the review: to identify factors associated with women’s preference to HB. **Specific objective 2 of the review: to determine the reasons of why women choose HB.

Figure 1 A flowchart diagram showing the selection process of included studies.

Note: Adapted from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.²¹

Box 2 Definition of Data Terms

Home birth: • Is defined as a birth that has taken place at the labouring woman’s own home, or her relative, or her neighbour. Predicting/significant/determinant factors: • Independent factors reported in selected studies as significantly associated with home birth at a P-value of less than 0.05. Reasons for homebirth: • Self-reported reasons of women for choosing home for giving birth to their child.

Table 2 Characteristics of Selected Studies

First Author Place.	Study Design.	Source of Data	Population—Eligibility Criteria	Outcomes—Relevant to Current Review Question	Quality Rating
Chernet 2018 National survey	Cross-sectional	EDHS 2016	10,622 women who gave birth within the last five years prior data collection	Homebirth, factors affecting homebirth	Average
Kebede 2013 Amhara state	Cross-sectional	Primary data	475 women who gave birth during the last 12 months	Homebirth, ANC, reasons for home birth, determinants of homebirth	Average
Hailu 2014 Tigray state	Cross-sectional	Primary data	485 women who gave birth during the last two years prior data collection	Homebirth, women empowerment, reasons for homebirth, determinants of homebirth	Average
Ababulgu 2016 SNNP state	Cross-sectional study	Primary data	504 mothers	Homebirth, determinants of homebirth, reasons for home birth, delivery attendant	Average
Kasaye 2017 Amhara State	Cross-sectional study	Primary data	501 women who gave birth during the last 12 months	Women empowerment, ANC, determinants of homebirth, reasons for homebirth, labour attendant	High
Yebyo 2015 National Survey	Cross-sectional	EDHS 2010–2016	7908 women who gave birth over five years-period.	Homebirth, women empowerment, factors affecting homebirth, ANC	High
Bayu 2015 Amhara State	Follow-up study	Primary data	422 pregnant women	Homebirth proportion, determinants of homebirth, reasons for homebirth	High
Mekie 2019 Amhara state	Cross-sectional study	Primary data	346 women who gave birth during the last 1 year	Women empowerment, homebirth proportion, reasons for home birth, labour attendants, determinants of homebirth	High
Tsegay 2017 Tigray state	Case Control	Primary data	285 women who gave birth during the last 12 months	Proportion of homebirth, Factors affecting homebirth	Average
Yaya 2018 National survey	Comparative study	EDHS survey	37,086 women of age 15–49	Reasons for homebirth, factors associated with homebirth	High

Table 3 The Reported Proportion of Homebirth in the Selected Studies

First Author	Homebirth
	n/N	%
Yebyo 2015	6980/7908	88%
Kebede 2013	402/475	85%
Kasaye 2017	764/909	84%
Hailu 2014	335/485	69%
Chernet 2018	7137/10,622	67%
Ababulgu 2016	312/504	62%
Mekie 2019	195/346	56%
Bayu 2015	156/422	38%
Tsegay 2017	95/285	33%
Total	16,503/22,457	73.5%

Table 4 Demographic Characteristics Associated with Homebirth

Yebyo (2015)	- Higher Educational level - Higher Parity - Exposure to media - Distance to get to health facilities - Residency (rural women give birth at home) - ANC attendance - Higher Economic level
Bayu (2015)	- Age (older women chose home) - Higher Educational level - ANC attendance
Hailu (2014)	- Higher Educational level - Distance from facilities - ANC visits - Higher Economic levels
Cherenet (2018)	- Higher Level of education - Economic background - Maternal age (older women preferred home birth)
Kasaye (2017)	- Educational level - Distance from facilities - ANC attendance - Time of occurrence (expected vs unexpected pregnancy)
Mekie (2019)	- Previous facility delivery - Distance from facility - Transport accessibility - ANC attendance
Kebede (2013)	- Previous facility delivery
	- Parity
	- ANC attendance
	- Distance from facility
Ababulgu (2016)	- Age - Educational level - Previous facility delivery - Parity
Tsegay (2017)	- Women’s access to media - ANC attendance - Level of knowledge about danger signs of pregnancy and childbirth
Yaya (2018)	- Residence. Rural vs urban residents

Table 5 Reasons to Give Birth at Home

Bayu (2015)	- Home is more comfortable (24%) - There was no problem to seek for care (22%) - Labour was incidental (20%) - Unwelcoming health professionals; negative previous experience at health facilities (15%) - It is my usual practice; labour was incidental (17%)
Hailu (2014)	- Needed family support (47%) - Not liking institutional delivery (43%) - Home feels more comfortable than hospitals (30.4%)
Kasaye (2017)	- Labour was simple and fast (76.4%) - Needed family support (35.4%) - It is cultural/usual practice (27.6%)
Mekie (2019)	- No transport (28.1%) - Long distance to get facilities (26%) - Trust in TBAs (18.4%) - Short labour (14.8%) - Unfriendly hospital care (12.8%)
Kebede (2013)	- Needed family support (35%) - Home maintains privacy (21%) - I do not know advantages of giving birth in hospitals (17%) - Long distance from health facilities and no transport to get there (12%) - Bad previous experience (12%)
Ababulgu (2016)	- Cannot afford transport: 36% responded to the question and highlighted the affordability issue
Yaya (2018)	- Not customary (28.8%) - Not necessary (54.9%) - Too far/no transport (14.6%) - Cost too much, no female provider, poor service (8%)

Notes: The percentages of the categories might not add up to 100% because participants have had more than one reasons.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372–n71. doi:10.1136/bmj.n71

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