The Effect of Distance to Health Facilities on Skilled Birth Attendance
DOI
https://doi.org/10.64146/2ssar093
Keywords:
Geographic accessibility, , maternal health, mixed methods, skilled birth attendanceAbstract
Maternal mortality remains disproportionately concentrated in geographically remote areas with limited resources, where skilled birth attendance is a crucial determinant of the survival of mothers and newborns. The objective of this study is to examine the effect of distance to health facilities on skilled birth attendance in Viqueque District, Timor-Leste, and to explore the mechanisms linking geographic remoteness to the use of health services. Methods a sequential explanatory mixed-methods design was employed. A cross-sectional survey of 410 women of reproductive age was conducted using multistage cluster sampling, and relationships among variables were evaluated using multivariate binary logistic regression; eighteen in-depth interviews and three focus group discussions were analyzed thematically. Findings the overall rate of births attended by trained health personnel was 51.2%, decreasing from 70.8% among women living within 5 km of a health facility to 20.8% among those living more than 10 km away. Distance remained the strongest independent predictor after adjustment (adjusted odds ratio 6.10; 95% CI 3.39–10.98). Having at least four antenatal visits, higher educational attainment, greater household wealth, readiness for childbirth, and knowledge of obstetric danger signs were also significant. Qualitative findings highlighted barriers related to transportation, cost, trust in service providers, family decision-making, and mobile phone reminders. The conclusion is that distance is a modifiable and dominant determinant of deliveries attended by trained health personnel in this setting; therefore, combined supply- and demand-side interventions are needed.
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