Prevalence and risk factors of home delivery among rural women: evidence from 28 African countries

Background
Home delivery continues to be a significant factor contributing to maternal mortality in Africa, particularly among rural women with limited access to skilled birth attendants and healthcare facilities. Factors influencing home delivery operate at individual, household, and community levels. Therefore, this study aimed to examine the prevalence and risk factors of home delivery among rural women in 28 African countries.

Methods
This retrospective cross-sectional study analyzed the most recent Demographic and Health Surveys (2011–2024) from 28 African countries. The weighted sample included 103,011 rural women of reproductive age. We performed descriptive analysis, chi-square tests, and binary logistic regression. Results are presented as frequencies, percentages, and odds ratios (ORs) with 95% confidence intervals (CIs). Statistical significance was set at p < 0.05.

Results
The overall prevalence of home delivery among rural women in Africa was 34.01% [95% CI: 23.33%-35.26%], ranging from 5.91% in Rwanda to 85.19% in Chad. Women with mistimed pregnancy [aOR = 0.79, 95% CI = 0.76–0.82] and those with unwanted pregnancy [aOR = 0.86, 95% CI = 0.81–0.92] had lower odds of home delivery. Risk factors included having four or more births [aOR = 2.04, 95% CI = 1.91–2.17], no/other religion [aOR = 2.41, 95% CI = 2.24–2.56] and those in Central Africa [aOR = 2.09, 95% CI = 1.98–2.19].

Conclusion
This research reveals that home delivery remains prevalent among rural women in Africa, with significant between-country disparities. Key risk factors include high parity, no/other religion, and Central African residence. Programs should prioritize multiparous women and expand maternal health services across all religious groups. Additionally, context-specific policies and targeted investments are needed in Central Africa to address regional disparities.