ArticleBMJ open2018
Effect of maternal age on facility-based delivery: analysis of first-order births in 34 countries of sub-Saharan Africa using demographic and health survey data.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Maternal and neonatal health service access and utilisation in sub-Saharan Africa (2015-2023): a systematic review and meta-analysis.BMC health services research · 2026Pooled it
- Inequalities in Access and Utilization of Maternal, Newborn and Child Health Services in sub-Saharan Africa: A Special Focus on Urban Settings.Maternal and child health journal · 2022Pooled it
- Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya.BMC pregnancy and childbirth · 2020Trial
- Prevalence and risk factors of home delivery among rural women: evidence from 28 African countries.Reproductive health · 2026Article
- Impact of extreme precipitation events on facility-based births in 21 sub-Saharan African countries.Nature communications · 2026Article
- Socioeconomic and geographic disparities in institutional delivery in Bangladesh: a Bayesian multilevel modelling framework.BMC public health · 2026Article
- Wealth-based inequality in maternal health service utilization among ever-married women of reproductive age in Somaliland; secondary analysis of the 2020 Demographic and Health Survey.Frontiers in public health · 2026Article
- Regional trends, spatial patterns and factors associated with health facility delivery among women of reproductive age in Sierra Leone.Reproductive health · 2025Article
- Analyzing factors affecting age at first birth among married women in Somalia: a Bayesian shared frailty modelling approach using SDHS 2020.BMC women's health · 2025Article
- Institutional Delivery in the Philippines: Does a Minimum of 8 Antenatal Care Visits Matter?Journal of preventive medicine and public health = Yebang Uihakhoe chi · 2025Article
- Article
- High risk fertility behaviour and health facility delivery in West Africa.BMC pregnancy and childbirth · 2023Article
- Primiparity at an Advanced Age: Emerging Pattern Needing Courtesy to Achieve SDG Maternal Health Targets.International journal of women's health · 2023Article
- Article
- Childlessness and Development in Sub-Saharan Africa: Is There Evidence for a U-shaped Pattern?European journal of population = Revue europeenne de demographie · 2022Article
- Intention to use maternal health services and associated factors among women who gave birth at home in rural Sehala Seyemit district: a community-based cross-sectional study.BMC pregnancy and childbirth · 2022Article
- Spatial inequalities in skilled birth attendance in India: a spatial-regional model approach.BMC public health · 2022Article
- Women's traditional birth attendant utilization at birth and its associated factors in Angolella Tara, Ethiopia.PloS one · 2022Article
- Socio-demographic factors associated with early antenatal care visits among pregnant women in Malawi: 2004-2016.PloS one · 2022Article
- Determinants of facility-based childbirth among adolescents and young women in Guinea: A secondary analysis of the 2018 Demographic and Health Survey.PLOS global public health · 2022Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesIncreasing access to skilled birth attendance, usually via childbirth in health facilities, is a key intervention to reduce maternal and perinatal mortality and morbidity. Yet, in some countries of sub-Saharan Africa, the uptake is <50%. Age and parity are determinants of facility-based delivery, but are strongly correlated in high fertility settings. This analysis assessed the independent effect of age on facility-based delivery by restricting to first-order births. It was hypothesised that older first-time mothers in this setting might have lower uptake of facility-based deliveries than women in the most common age groups for first birth.
settingThe most recent Demographic and Health Surveys from 34 sub-Saharan African countries were used to assess women's delivery locations.
participants72 772 women having their first birth in the 5 years preceding the surveys were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Proportions and 95% CIs of facility-based deliveries were estimated overall and by country. Multivariable logistic regression was used to calculate the odds of facility-based delivery for different maternal age groups (15-19, 20-24 and ≥25 years) for a pooled sample of all countries.
results59.9% of women had a facility-based delivery for their first birth (95% CI 58.6 to 61.2), ranging from 19.4% in Chad to 96.6% in Rwanda. Compared with women aged 15-19 years, the adjusted odds of having a facility-based delivery for those aged 20-24 was 1.4 (95% CI 1.3 to 1.5, p<0.001) and for those aged ≥25, 1.9 (95% CI 1.6 to 2.2, p<0.001).
conclusionsOlder age at first birth was independently associated with significantly higher odds of facility-based delivery. This went against the hypothesis. Further mixed-method research is needed to explore how increased age improves uptake of facility-based delivery. Promoting facility-based delivery, while ensuring quality of care, should be prioritised to improve birth outcomes in sub-Saharan Africa.
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