Over the last two decades, Gambia has made noticeable progress in the reducing the high maternal mortality rates and improving child survival rates. Nonetheless, numerous infrastructural and financial constraints continue to restrict access to institutional delivery care, a key component of achieving the maternal and child health related Sustainable Development Goals (SDG 3.1). This study assesses factors that predict women’s choice of mode and place of delivery in urban and rural Gambia. Cross-sectional data from the latest round of Gambia Demographic and Health Survey (2013) on women aged 15–49 years (n = 5351) were analyzed. The outcome measures were place (home vs health facility) and mode of delivery (caesarean vs normal) in urban and rural Gambia. Data were analyzed using descriptive and multivariate regression methods. About three-fifth (60.8%) of the participants had their last childbirth at a health facility and 39.2% at their home. There was a significant urban-rural difference in the prevalence of facility delivery with 86.9% of the urban women choosing health facility over home compared with 45.8% among the rural women. In the regression analysis, place of residence, education of participants and the husband, employment, parity and use of antenatal care were significantly associated with the use of health facility delivery services. For instance, having secondary [OR = 1.657, 95%CI = 1.337,2.053] and higher education [OR-2.451, 95%CI = 1.166,5.150] showed higher odds for using facility delivery services; and women from the richest wealth quintile had significantly higher [OR = 2.239, 95%CI = 1.525,3.289] odds of using facility delivery compared with those in the lowest quintile. Our findings suggest a sub-optimal use of professional childbirth services among Gambian women which appears to be driven by various geographical, educational, wealth inequality, parity and low use of ANC services. Addressing the socioeconomic and demographic inequalities may lead to a more widespread usage of maternity services in Gambia.

中文翻译：

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冈比亚育龄妇女机构分娩服务利用的预测因素：横断面分析

过去二十年来，冈比亚在降低孕产妇高死亡率和提高儿童存活率方面取得了显着进展。尽管如此，众多基础设施和财政限制继续限制机构分娩护理的获得，而机构分娩护理是实现妇幼健康相关可持续发展目标（SDG 3.1）的关键组成部分。本研究评估了冈比亚城乡妇女选择分娩方式和地点的预测因素。对最新一轮冈比亚人口和健康调查（2013 年）中 15-49 岁女性（n = 5351）的横断面数据进行了分析。结果指标是冈比亚城市和农村的地点（家庭与医疗机构）和分娩方式（剖腹产与正常）。使用描述性和多元回归方法对数据进行分析。大约五分之三 (60.8%) 的参与者最后一次分娩是在医疗机构进行的，39.2% 的参与者是在家中分娩的。设施分娩率存在显着城乡差异，86.9%的城市妇女选择医疗机构而不是家庭，而农村妇女的这一比例为45.8%。在回归分析中，居住地、参与者和丈夫的教育程度、就业、产次和产前保健的使用与医疗机构提供服务的使用显着相关。例如，拥有中学教育 [OR = 1.657, 95%CI = 1.337,2.053] 和高等教育 [OR-2.451, 95%CI = 1.166,5.150] 显示使用设施交付服务的几率更高；与财富最低的五分之一的女性相比，来自最富有的五分之一的女性使用设施分娩的几率显着更高 [OR = 2.239, 95%CI = 1.525,3.289]。我们的研究结果表明，冈比亚妇女对专业分娩服务的使用效果不佳，这似乎是由各种地理、教育、财富不平等、平等和非国大服务使用率低造成的。解决社会经济和人口不平等问题可能会导致冈比亚更广泛地使用孕产服务。