Determinants of choice of childbirth place in the health districts of Anié and Kéran, Togo

Introduction: In low-income countries such as Togo, as well as in middle-income countries, a significant number of births still occur at home without the assistance of skilled health personnel. These home deliveries are associated with maternal and neonatal deaths within communities and remain a major concern for development stakeholders across Sub-Saharan Africa. Objective of the Study: The aim of this study was to identify the factors influencing the choice of childbirth place in the health districts of Anié (Plateaux region) and Kéran (Kara region) in Togo. Methods: This was a cross-sectional, mixed-methods, and analytically oriented study that employed logistic statistical techniques alongside qualitative methods. Data were collected from 303 women between December 2023 and February 2024. Results: The mean age of the women surveyed was 26.33 ± 0.50 years. The results showed that the likelihood of a woman delivering in a health facility increased by a factor of 1.086 for each additional year of age (p = 0.000; OR = 1.086; 95% CI [1.042 – 1.131]). Women residing in rural areas were 2.873 times more likely to deliver at home than in a health facility (p = 0.010; OR = 2.873; 95% CI [1.283 – 6.435]). Women who attended antenatal care (ANC) for each pregnancy were 6.790 times more likely to deliver in a health facility compared to at home (p = 0.000; OR = 6.790; 95% CI [2.637 – 17.481]). Women who had knowledge about vaginal delivery assisted with medical instruments in a Basic Emergency Obstetric and Newborn Care (BEmONC) facility were 1.852 times more likely to deliver in a health facility than at home (p = 0.026; OR = 1.852; 95% CI [1.078 – 3.182]). Conclusion: This study showed that a woman’s age and age at marriage, her place of residence, antenatal care (ANC) attendance for each pregnancy, knowledge of danger signs related to childbirth, and awareness of the services provided by Basic Emergency Obstetric and Newborn Care (BEmONC) facilities are key determinants of her choice of delivery location. Keywords: Home birth, Determinants, EmONC, Kéran, Anié, Togo