References
Association between non-institutional birth and antenatal care in rural areas of Peru
Abstract
Background/Aims
In low- and middle-income countries, home births and non-institutional births can be associated with higher risk of mortality and morbidity. The aim of this study was to evaluate the association between the content and quality of antenatal care given to women in rural areas of Peru and the location of their child's birth.
Methods
An observational study was conducted using secondary data from a national survey in Peru for 2022. The association between the content of antenatal care and home births was assessed using a generalised linear model and prevalence ratios were calculated.
Results
A higher prevalence of home birth was observed if one or more aspects of care (P<0.001), examinations (P=0.008) or counselling (P<0.001) were not met. Similarly, the prevalence of home births was higher among women who attended <6 antenatal visits (P<0.001) and if the care was provided by someone other than a qualified healthcare professional (P<0.001).
Conclusions
The content and quality of prenatal care may influence the likelihood of a woman having a home birth, which in the Peruvian context may result in a higher level of morbidity and mortality. Barriers to healthcare services persist in rural areas.
Implications for practice
It is the responsibility of the healthcare system to ensure adequate provision of antenatal care in rural areas. Future studies should assess deficiencies in healthcare services to improve antenatal care and reduce the risks associated with non-institutional birth.
Non-institutional birth refers to childbirth occurring outside of appropriate healthcare settings or performed by an untrained person (Ossai et al, 2021). While home births in high-income countries may offer benefits, such as personalised care and a familiar environment, when supported by trained professionals as part of an organised healthcare system (Brunton et al, 2021), this is not the case in low- and middle-income countries. Limitations in the healthcare system, such as access to health services and unequal distribution of healthcare professionals, mean that home births are associated with higher risks and negative health outcomes for mothers and newborns (Chinyakata et al, 2021; Espinoza-Portilla et al, 2021; Houghton et al, 2023).
The global prevalence of non-institutional birth is 28% and can reach up to 35% in lower-middle income countries (Hernández-Vásquez et al, 2021). While the prevalence of non-institutional birth in Peru is 8.7%, it increases to 19.6% in rural areas (Huapaya Torres et al, 2022). Non-institutional births are associated with increased maternal and perinatal mortality (Lee et al, 2022; Izulla et al, 2023), as many mothers do not receive necessary medical assistance during childbirth or give birth in an uncontrolled setting, with significant deficiencies in essential care (Islam et al, 2024). In cases of non-institutional birth in lower-income countries, complications such as obstetric haemorrhage, intrapartum infection, hypertensive disorders and preterm birth present a higher mortality risk as a result of the lack of adequate healthcare staff, infrastructure and resources (Schrey-Petersen et al, 2021).
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