Mariyam Sarfraz, Aashifa Yaqoob, Saima Hamid.
Contextual determinants of skilled birth attendant utilization: an in-depth analysis of Pakistan demographic household survey.
Pak J Public Health Jan ;3(4):31-8.

Introduction: Timely recognition and prompt treatment of maternal complications arising during pregnancy and delivery can improve the maternal deaths and the morbidity resulting from complications. Considering the maternal health situation in Pakistan, this paper looks specifically at the factors affecting the skilled birth utilization. The objective of this study is to explore and identify the contextual determinants for the uptake of skilled birth attendants by women of reproductive age in the urban and rural areas of Pakistan. Methods:Data from the Pakistan Demographic and Health Survey 2006–2007 was used. The dependant variable in the analysis was “delivery assisted by the skill birth attendant (SBA)” which included doctors, nurses, midwives, and lady health visitors. A multistage process was used to create a final model for the dependent variable (delivery conducted by skill birth attendant). Bi-variate relationships between the each independent variable and outcome variable were investigated using a binary logistic model. Those independent variables found to be significant at the bi-variate level were included in a multivariate regression model for outcome variable. Results:More than two third of the respondents (63.3%) were less than thirty (< 30) years in age and one fourth of the women were working women. Overall literacy for women was low with only 35.4% of the women literate. More than 80% of the fathers were less than 40 years of age and 85.4% of them were formally employed. 63.1% of the respondents were from a rural area, whereas only 36.9% were from urban locality. The results of multivariate regression show that wealthy, literate women from urban areas who undertook regular ante natal care from a skilled provider and practiced family planning were more likely to utilize a skilled birth attendant at delivery. Conclusion: This study has identified major determinants for a skilled birth attendant utilization as respondents’ education, financial/economic status (ability to pay), access to a health facility, antenatal care use and a positive history of family planning. Promoting the availability of and access to skilled birth attendants during delivery, especially in the rural and under-developed areas, is essential for achieving gains in MDG 5.

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