Who are the women having non-institutional deliveries in Brazil and who attends them? An analysis of 13.7 million births, 2018-2022.

Objective: To identify groups of women in Brazil more likely to have deliveries outside health facilities and the types of professionals attending these deliveries, and to assess related social determinants. Methods: Data from Brazil's Live Birth Information System from 2018 to 2022 were used to investigate non-institutional deliveries by region of residence, ethnicity/skin color, schooling, and maternal age at delivery. Associations between these factors were also assessed. The proportion of births attended by doctors, nurses/midwives, traditional birth attendants, and others was also analyzed, comparing institutional and non-institutional deliveries. Results: The overall prevalence of non-institutional deliveries was 1.0%. Higher proportions were observed in the North region (4.0%), and among Indigenous women (26.3%), adolescent mothers (1.4%), and women with fewer than 4 years of schooling (8.3%). The proportion of non-institutional deliveries was 67.6% among, Indigenous women from the North region with little education. Indigenous women with fewer than 4 years of schooling and who had a non-institutional delivery had the highest proportion of deliveries without a qualified professional (95.2%). Conclusions: Cultural norms and barriers to accessing maternity services, combined with broader social inequalities and organizational challenges faced by Indigenous populations, may contribute to the high proportion of non-institutional deliveries without a skilled attendant observed among these women. Culturally sensitive strategies to expand access to maternity care for and empower Indigenous women are crucial to ensure their and their children's survival.