Determinants of Maternal Delay in Utilizing Institutional Delivery Services in West Gojjam Zone, Ethiopia: A...

The time interval between the onset of labor and the decision to use institutional delivery is referred to as a delay in deciding to use institutional delivery services. The delay in deciding to use institutional delivery is the first of the three delays that prevent mothers from accessing appropriate care during the time of delivery. In this study, maternal delay was operationally defined as the time interval of over an hour after the onset of labor before a decision is made to use institutional delivery services, based on prior evidence indicating that early decision-making is critical for preventing obstetric complications. Globally, such delay remains a major challenge affecting both maternal and neonatal health, including in Ethiopia. Therefore, assessing the magnitude of this delay and its associated factors is essential to reducing maternal morbidity and mortality.

To assess the magnitude of maternal delay in utilizing institutional delivery services among postnatal mothers in government hospitals of the West Gojjam Zone and to identify the factors associated with the delay.

A cross-sectional study was conducted among 402 postnatal mothers. Systematic random sampling was applied, and data were collected using a face-to-face, interviewer-administered questionnaire. Data entry was performed using EpiData version 4.6, and analysis was carried out with SPSS version 26. Variables with a p-value ≤ 0.25 in the bivariable analysis were included in the multivariable logistic regression model. Statistical significance was declared at an adjusted odds ratio with a 95% confidence interval and a p-value < 0.05.

The magnitude of maternal delay in utilizing institutional delivery services was 39.8% (95% CI: 34.8-45.0). Unable to read and write (AOR = 2.5; 95% CI: 1.15-5.53), mothers with primary education 2.76 (AOR = 2.76 95% CI:1.03,7.41) mothers who could not make decisions independently (AOR = 4.1; 95% CI: 1.37-12.40), unplanned pregnancies (AOR = 3.6; 95% CI: 1.21-10.70), no antenatal care follow-up (AOR = 4.4; 95% CI: 1.11-12.35), did not receive respectful maternity care during previous facility-based childbirth (AOR = 3.8; 95% CI: 1.32-11.16) were significantly associated with delays in deciding to use institutional delivery services.

Almost forty percent of mothers face a delay in deciding on utilizing institutional delivery services. Lack of education in reading and writing, absence of autonomy in decision-making, unplanned pregnancy, absence of antenatal care, and disrespectful care during maternity were found to be significant delays in utilizing institutional delivery services. Improving maternal education, promoting autonomy, improving utilization of antenatal care, and promoting respectful care are critical in reducing delays in utilizing delivery services.