Home Delivery Practices among Pregnant Women in Southeast of Iran and Associated Factors after the Implementation of the Health Transformation Plan: a Case-control Study

Free-of-charge vaginal deliveries have been offered as part of the Health Transformation Plan (HTP) in Iran, but still a high proportion of deliveries are occurring at home. This study aimed to investigate the reasons for home deliveries after the implementation of HTP in southeast of Iran. This case-control study included women who gave birth at home between September 2015 and September 2016 for their last pregnancy; considered as cases (n=300), and women who delivered at a health facility (hospital or Safe Delivery Posts), assigned to the control group (n= 600). Data were collected during face to face interview using a 77-item semi-structured questionnaire. A multivariable logistic regression technique was used to identify independent predictors of home delivery. Women who were worried about giving birth at a teaching hospital (OR=1.9, 95% CI:1.3 -2.8), women with negative experiences in the previous delivery (OR=1.6, 95% CI:1.0-2.4), illiterates (OR=3.8, 95% CI: 2.0-7.4), individuals with primary/secondary education (OR=2.3, 95% CI: 1.3 - 4.4), women with no health insurance (OR=5.1, 95% CI: 3.5- 7.4), if the decision on choosing the place of birth was made by the women alone (OR=12.7, 95% CI: 7-22.8), women with financial constraints (OR=1.7, 95% CI: 1.2-2.4), women with precipitate labour (OR=2.4, 95% CI: 1.7-3.5) and women with fear of the hospital environment (OR= 1.6, 95% CI: 1.1- 2.4) were more likely to deliver at home. Our findings highlight socio-economic and cultural barriers that need to be addressed to reduce home deliveries among the disadvantaged women.