Women's choice of delivery site and the surge in private facility-based deliveries in Pakistan: A 28-year trend analysis

Objective. This paper aims at estimating the long-term trends of facility-based and home-based deliveries and identifies the factors associated with the choice of delivery site. Study design: Secondary analysis evaluating the trends in the choice of the delivery site by women of reproductive age using Pakistan Demographic and Health Surveys from 1990-91 to 2017-18. Main outcome measures: The main outcome measure of this study is the choice of delivery site. Method: This study used data from four waves of Pakistan Demographic and Health Surveys (DHS) corresponding with 1990-91, 2006, 2012-13 and 2017-18. Logistic regression was used for empirical analysis. Results: The odds of home delivery significantly came down in 2017-18 relative to 1990-91 (OR = 0.09; 95% CI:0.08-0.12; P < 0.001), growth in the likelihood of institutional delivery shows wide disparities. While the odds of delivery at the public health facility nearly doubled from 1990 to 91 to 2017-18 (OR = 2.12; 95% CI:1.70-2.65; P < 0.001), the odds of delivery at the private health facilities in the same period increased nearly eight times (OR = 7.78; 95% CI:6.45-9.38; P < 0.001). Conclusion: Results suggest an investment gap in public health facilities and an inequitable health care system in Pakistan.