Women's Empowerment and Homebirth in Sierra Leone. A Secondary Analysis of the 2019 Sierra Leone Demographic Health Survey

Abstract Background A nationwide assessment of the link between women's empowerment and homebirth has not been examined in Sierra Leone. Our study examined the association between women's empowerment and homebirth using the 2019 Sierra Leone Demographic Health Survey (2019 SLDHS) data. Method We used the individual file (IR) of the 2019 SLDHS dataset for our analysis. A total of 7377 women aged 15–49 years who gave birth in the five years preceding the survey were included in our study. Our outcome variable was "home birth of their last child among women in the five years preceding the 2019 SLDHS. Women's empowerment parameters include women's knowledge level, economic participation, decision-making ability, and attitude towards wife beating. We used the complex sample command on SPSS version 28 to conduct descriptive and multivariate logistic regression analyses. Results Three in every 20 women had home childbirth (n = 1177,15.3%). Women with low [AOR = 2.04.;95%CI: 1.43–2.92] and medium [AOR = 1.44;95%CI: 1.05–1.97] levels of knowledge compared to those with high levels of knowledge had higher odds of giving birth at home. Women who were in favour of wife beating were more likely to have had homebirth compared to those who were against wife beating [AOR = 1.38;95%CI:1.09–1.74]. In addition, women with no [AOR = 2.71;95%CI:1.34–5.46) and less than four [AOR = 2.08;95%CI:1.51–2.88] antenatal care visits and who considered the distance to a health facility as a major problem [AOR = 1.95;95%CI:1.49–2.56] were more likely to have had a home birth. However, no significant association between a women's decision-making power and home birth was observed [AOR = 1.11;95%CI:0.86–1.41]. Conclusion Despite improvements in maternal health indicators, homebirth by unskilled birth attendants is still a public health concern in Sierra Leone. Women with low knowledge levels, who favour wife beating, had less than four ANC visits and considered distance to a health facility as a major problem had higher odds of giving birth at home. Our findings reflect the need to empower women by improving their knowledge level through girl child and adult education, increasing media exposure, changing societal norms and unequal power relations that favour gender-based violence, and improving roads and transport infrastructure.