Characteristics and determinants for home births in rural Sierra Leone: A cross-sectional study

Background: Sub-Saharan Africa and Sierra Leone bear one of the world’s highest maternal mortality rates. In rural Sierra Leone, 19% of births occur at home, contributing to high maternal mortality ratios. Objective: To identify characteristics and reasons for home births among women in the rural Mathonkara Catchment area, Sierra Leone. Design: Cross-sectional study. Setting: 23 rural villages in the Mathonkara Catchment Area, Sierra Leone. Population: Women of childbearing age, who gave birth, miscarried or had an abortion between February 1, 2022, and January 31, 2023. Methods: A structured questionnaire assessed birthplaces, demographic characteristics, maternal health indicators, care seeking behaviors and previous experiences of care at health facilities. Main Outcome Measures: Prevalence of home births and associated determinants. Results: 555 women were included. The prevalence of home births stood at 26.67%. Characteristics associated with home births included feeling healthcare workers did not care about your life (AOR=19.11; 95% CI:1.57-799.61), living >1 km from a health facility (AOR=7.15; 95% CI:3.12-16.51), ≤3 antenatal care visits (AOR=4.84; 95% CI:2.37-10.14) and previous home births (AOR=4.17; 95% CI:2.42-7.30). Barriers included nighttime labor, transportation costs and availability and healthcare service costs. Conclusion: The factors influencing home births in rural Sierra Leone are multifaceted. To improve maternal outcomes, it is crucial to address the challenges that impede facility-based births, including quality of care and respectful care at health facilities, distance, economic costs of reaching facilities and transportation challenges such as quality of roads and availability of transportation. Keywords: Maternal Health, Sierra Leone, Home Birth, Antenatal care, Tonkolili