Determinants of Utilization of Institutional Delivery Services in Zambia: An Analytical Cross-Sectional Study.

Institutional delivery at birth is an important indicator of improvements in maternal health, which remains one of the targets of sustainable development goals intended to reduce the maternal mortality ratio. The purpose of the present study was to identify the determinants of utilization of institutional delivery in Zambia. A population-based cross-sectional study design was used to examine 9841 women aged 15-49 years from the 2018 Zambia Demographic and Health Survey. A multiple logistic regression was applied to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to identify determinants of utilization of institutional delivery. Sociodemographic factors were significantly associated with institutional delivery: woman's (OR: 1.76; 95% CI: 1.04-2.99) and husband's (OR: 1.83; 95% CI: 1.09-3.05) secondary/higher education, higher wealth index (OR: 2.31; 95% CI: 1.27-4.22), and rural place of residence (OR: 0.55; 95% CI: 0.30-0.98). Healthcare-related factors were also significantly associated with institutional delivery: 5-12 visits to antenatal care (OR: 2.33; 95% CI: 1.66-3.26) and measuring blood pressure (OR: 2.15; 95% CI: 1.32-2.66) during pregnancy. To improve institutional delivery and reduce maternal and newborn mortality, policymakers and public health planners should design an effective intervention program targeting these factors.