The grim face of home births, perinatal deaths, and the protective role of food security and social support among pregnant women in Southwestern Uganda

The grim face of home births, perinatal deaths, and the protective role of food security and social support among pregnant women in Southwestern Uganda | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The grim face of home births, perinatal deaths, and the protective role of food security and social support among pregnant women in Southwestern Uganda Esther C Atukunda, Godfrey R Mugyenyi, Jessica Haberer, Van T Nghiem, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8681001/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Up to 30% of Uganda’s births occur outside formal health facilities, where there are higher risks of maternal and perinatal deaths. Strategies to encourage facility-based delivery are needed. In this paper, we study patterns of home births and perinatal deaths and evaluate factors that could mitigate their risk among pregnant women in southwestern Uganda. Methods We analyzed baseline data from a prospective cohort of pregnant women in rural Uganda. Pregnant women were recruited through community health teams and networks. Enrolled women completed an interviewer-administered questionnaire to collect data on sociodemographic characteristics, reproductive history, prior birth and pregnancy outcomes, household food security, and perceived social support. We used multivariable logistic regression to assess factors associated with home birth, its association with perinatal deaths, and explore the protective roles of sociodemographic, food security and social support. Results Among 699 women enrolled, mean age was 27.8 (standard deviation [SD] 6.3) years, median gestational age was 14 (IQR = 12–17) weeks, 67 (9.6%) reported to be HIV positive and 341 (48.8%) of previous pregnancies were planned. Only 256 (36.6%) reported a monthly household income > 150,000UGX (approximately 40USD/month). One-hundred and twenty (17.2%) women reported a home birth in their last pregnancy. Eighty-nine (12.7%) women reported a history of perinatal death in their last pregnancy. History of home birth was associated with age > 35 years (AOR = 2.29[1.04–5.05]; P = 0.004), no or lower than primary education (AOR = 3.85[2.11–7.03]; P 3 (AOR = 1.62[1.37–1.92]; P < 0.019), unplanned prior pregnancy (AOR = 1.26[1.01–2.03]; P = 0.033), poor instrumental social support (AOR = 1.88[1.33–2.47]; P < 0.019), and household food insecurity (AOR = 1.87[1.23–2.77]; P < 0.001). Higher adjusted odds of perinatal deaths were reported among women that delivered from home (AOR = 2.45[1.39–4.33; P = 0.002). Conclusions We observed higher rates of home births among older women, those with low educational attainment, and those with low social support and household food insecurity. Perinatal deaths were more common among women who delivered from home. Scalable strategies are needed to support safer birth choices and reduce maternal and neonatal deaths in such resource-limited settings. Trial registration This trial was fully registered on 10th July 2023 on ClinicalTrials.gov NCT05940831 https//clinicaltrials.gov/study/NCT05940831 birth choices home birth maternal care access social support food security Uganda BACKGROUND Over 99% of infant deaths occur in low and middle-income countries (LMICs) [ 1 , 2 ]. Persistently high maternal mortality rates in LMICs are partly attributed to challenges accessing care, poor antenatal care (ANC) attendance, with undiagnosed or poorly managed pregnancy-related complications from direct or indirect causes[ 3 ]. Uganda has long faced high maternal (189/100,000), and perinatal (38 deaths/1000 births) mortality with up to 30% of births occurring outside formal health facilities [ 4 , 5 ]. The factors driving this trend are complex. Geographic, financial, and sociocultural barriers such as distance to health facilities, transport costs, user fees shape home delivery decisions, and contribute to increased risks of childbirth complications and preventable obstetric mortality [ 4 – 7 ]. Women’s lack of information, social support, financial independence for emotional and economic provisions, decision-making autonomy regarding childbirth, birth preparedness, and perceived need for responsive and respectful maternity care services are important challenges to utilizing available maternity services in these settings [ 3 , 8 – 11 ]. Women at risk of unskilled home births need relevant and context specific strategies to encourage ANC attendance and skilled delivery [ 12 ]. Strong social support networks such as family, friends, relatives, community health workers and networks, play a critical role in providing emotional, informational, physical and financial resources that could facilitate timely decision making needed to overcome critical "delays" in referrals and care-seeking during pregnancy and delivery [ 13 – 22 ]. Social support can shape maternal health behaviors and decisions about where to deliver, facilitate health service uptake, birth planning, buffer economic shocks and accelerate timely help-seeking and or access to facility delivery[ 14 , 23 ]. Poor networks and social capital have been linked to greater reliance on home-based or traditional approaches during pregnancy and delivery [ 24 , 25 ]. Social network involvement therefore not only addresses individual, but also family and societal/ community-level barriers to care in a setting with modest availability of health centers providing needed services [ 9 , 14 , 26 – 28 ]. Food insecurity and poor nutrition during pregnancy may lead to anemia, infections, hypertensive/metabolic disorders, low birthweight and increased risk of maternal and neonatal complications [ 29 ]. In resource-limited settings, food insecurity often coexists with poverty and may exacerbate vulnerability, constrain families’ ability to transport to facilities or pay for services [ 30 ], particularly in rural Southwest Uganda where agriculturally dependent communities predominate [ 31 , 32 ]. Whereas the literature highlights the valuable role of support networks, the specific influence of food security on the choices and outcomes related to home births and perinatal deaths in Uganda remains a critical gap in the literature. Food insecurity may affect birth planning and access to skilled care partly through direct impacts on maternal energy in late pregnancy but also informing decisions about when and where to deliver, particularly where transport and service costs compete with other urgent household needs. Some reports further suggest that adequate nutrition supports maternal resilience and confidence, that may influence birth planning, care-seeking, adherence to antenatal care, capacity to participate in recommended maternal-newborn practices and birth place decisions[ 33 ]. There is limited evidence from rural Uganda and similar settings that examines: (i) the socio-cultural drivers of home birth, (ii) the sub categories of women associated with home birth, (iii) how home births correlate with perinatal mortality in a community-recruited population, and (iv) how social support networks and household food security influence birthplace choices and perinatal outcomes (socioeconomic determinants). We assess this matrix from a diverse mix of rural and peri-urban communities of southwestern Uganda with varying levels of health facility availability, transportation infrastructure, sociocultural and economic diversity to better understand the contributors to home births and motivate interventions which might address them. METHODS Study Design and Setting We analyzed baseline data collected from pregnant women who had had at least one prior birth and enrolled in a randomized controlled trial in southwestern Uganda. The parent trial aims to evaluate the effect of a messaging intervention in improving utilization of available maternity care services, and ultimately reduce maternal and perinatal mortality (NCT05940831)[ 34 ]. Uganda’s public health system is organized into seven tiers with national and regional referral hospitals, general district hospitals and four levels of community health centers (HC). Staffing and available services vary across the four levels: HCIII carry out vaginal deliveries, whereas HCI and HCII serve as low resource referral units. HCIVs and hospitals conduct normal and caesarean deliveries, and have ambulances and blood transfusion services[ 35 ]. Private providers operate in parallel to the public health system to provide maternal healthcare. Mbarara and Mitooma districts within Southwestern Uganda, encompass rural, peri-urban, and smaller urban centers to capture diversity in access to health services and food security conditions. These two sites were selected for this research based on their geographic, socio-cultural, and institutional diversity, and high maternal mortality and morbidity data. Both districts have publicly funded and operated facilities with active maternity care units. The local economy of these two districts is also largely based on subsistence agriculture, with both food and water insecurity being common [ 31 , 32 ]. Maternity services, including delivery, are largely provided free of charge through public HCs. Participants and Recruitment Women were eligible if they were pregnant at < 20 weeks of amenorrhoea (determined by last normal menstrual period or ultrasound scan where available) had not yet presented for ANC and resident of areas within a 10 km radius of publicly funded maternity centers in Mbarara and Mitooma districts. Eligible women were aged 15–49 years, with at least one prior live birth. Participants were asked to identify two individuals from their existing social support network with whom they have had stable, long-term relationships and believe they would be available to help them during the pregnancy and study follow-up period. Women unable to complete baseline interview (e.g., severe cognitive impairment) or who had language barriers not addressable by interpreters were excluded. Community/Village Health Teams (C/VHTs) notified study research assistants about potentially eligible participants. Trained research assistants (RAs) approached women referred by C/VHTs and obtained voluntary written informed consent from all eligible participants. All consenting participants gave written informed consent, or for those who could not write, a thumbprint was made on the consent form. Study Groups Women were screened for eligibility and equally randomized 1:1 into the intervention arm (messaging intervention) and standard of care (control group) between November 2023 and July 2025. These women are being followed until delivery. All participants completed baseline interviewer-administered interviews. Interviews were conducted by four trained research assistants fluent in English and the main local language in a private office space. Each interview took about 45–60 min. Data was collected electronically. A transport refund of $ 5 was given on each visit. Data Collection A structured face-to-face questionnaire was completed at enrolment to collect information on socio-demographics, health [ 12 ], pregnancy planning, reproductive history, partnership dynamics (e.g. HIV serostatus/ disclosure, partner HIV-serostatus), decision making [ 4 , 6 , 13 , 14 , 15 , 16 , 17 , 18 ], HIV and stigma [ 22 ], and alcohol use in the last 12 months [ 36 , 37 ] due to its association with health outcomes. We collected reported the distance to nearest health facility, availability of midwives, history of home/facility birth, community support for alternative birthing choices, and relationships with health care providers. We measured food insecurity using the Household Food Insecurity Access Scale (HFIAS) [ 38 ]. We adopted and measured social support using a version of the Duke-UNC Functional Social Support Scale [ 39 ], a tool that has been widely used in Uganda [ 40 ]. Health, pregnancy, childbirth beliefs, knowledge, risk awareness, need for skilled delivery and childbirth practices were assessed as per previous studies in the same setting [ 9 , 12 , 26 ]. We adopted the 6 items used in Uganda to assess pregnancy risk assessment, personal and partner pregnancy desires [ 41 – 43 ], 18 questions/statements reflecting 6 parenthood motives [ 44 ]. We assessed gender-based violence [ 45 ], and relationship power [ 46 – 48 ] given its relationship with home births in Uganda [ 9 ]. These survey data included the self-reported date and location of the previous birth, whether there was a skilled birth attendant present, mode of delivery (ie. vaginal vs C-section delivery), birth outcome; including preterm birth, still births, newborn deaths. Statistical Analysis We describe demographic and clinical data for the cohort using standard descriptive statistics. We assessed the prevalence and covariates of home birth delivery for the last pregnancy. The Household Food Insecurity Access Scale (HFIAS) was calculated as recommended [ 38 ]. Social support received by women was measured using the Duke-UNC Functional Social Support Questionnaire [ 39 ]. The primary outcome of interest was home birth delivery. Univariable logistic regression was used to assess unadjusted associations between covariates and home birth, expressed using crude odds ratio and 95% confidence intervals. We utilized Andersen’s Healthcare Utilization Model [ 49 ] to pick covariates. Variables with p value ≤ 0.20 in unadjusted analyses were considered for inclusion in a multivariable logistic regression analysis. Variables examined in the unadjusted model found to be collinear were selectively excluded from the multivariate models. Analysis to establish the effect on perinatal mortality by reported home birth was also done. Statistical significance was defined at the level of p ≤ 0.05. All data analyses were performed using STATA version 17.0 (Statacorp, College Station, Texas, USA). Human Ethics and Consent to Participate declarations missing This study was approved by the Institutional Review Council of Mbarara University of Science and Technology (MUST-2022-631) and Uganda National Council of Science and Technology (HS3366ES), and registered with clinicaltrials.gov (NTC05940831). Study site administrative permission was obtained. We obtained informed consent from all participants, including emancipated minors under 18 years of age as per Uganda’s regulations. RESULTS Participant Characteristics A total of 1206 women were screened for eligibility, 824 women were eligible and enrolled (191 had already initiated ANC visits, 153 had gestation age > 20 weeks, 38 were not interested in the study). Out of the 824, 699 reported a previous childbirth and were included in this analysis. The mean maternal age was 27.8 (standard deviation [SD] 6.3) years. Women who reported more than primary education were 40.9% (n = 286). The median gestational age was 14 (IQR = 12–17) weeks, up to 97% were married or cohabiting (n = 680), 67 (9.6%) reported to be HIV positive, mostly disclosed (n = 60, 8.6%) and antenatal attendance > 4 visits in the last pregnancy was approximately 59% (n = 407). Only 256(36.6%) reported household income > 150,000 Ugandan Shilling (~ 40 USD) per month. Vaginal delivery in last pregnancy was reported to be about 78% (n = 616), 341(48.8%) of previous pregnancy was planned. The average birth interval and children < 18 years of age in household were reported to be 11 (IQR = 8–21) months and 2 (IQR = 1–3) respectively. Up to 80% (n = 558) of women reported low decision-making power, with most women residing averagely within 4km radius to a publicly funded health facility (IQR = 3–6). About 42.2% (n = 295) experienced severe food insecurity, and alcohol consumption in the past 12 months was reported by 14% (n = 98). Half of participants (49.5%) received moderate to adequate social support (median score = 2.1[IQR = 1.8–3.1]). Eighty-nine (12.7%) of women reported history of perinatal death in their last pregnancy. No reported home birth was attended by a skilled healthcare provider. Other baseline characteristics are presented in Table 1 . Table 1 Baseline demographic and clinical characteristics of pregnant women with a recent childbirth in SW Uganda, N = 699 Characteristics Mean(SD) or Median(IQR) or n(%) Mean age (completed years) 27.8 (6.3) Education attainment greater than primary 286 (40.9) Median weeks of gestation period (IQR) 14 (12–17) Marital status Married/cohabiting 680 (97.3) Never married 19 (2.7) HIV status Positive 67 (9.6) Negative 622 (89.0) Unknown 10 (1.4) HIV Disclosure to spouse/partner (among those reporting positive) 60 (89.6) Pregnancy disclosure to spouse/partner 685 (98.0) Parity 1 264 (37.8) 2 147 (21.0) 3 139 (19.9) 4 86 (12.3) ≥ 5 63 (9.0) ANC visits ≥ 4 407 (58.8) Household income > 150000 = Shs* per month 256 (36.6) Vaginal mode of delivery for last pregnancy 616 (78.4) Last pregnancy was planned 341 (48.8) Current pregnancy planned 412 (58.9) Average birth interval from previous to current pregnancy (months) 11 (8–21) Children < 18 years in household, median (IQR) 2 (1,3) Distance to a publicly funded health facility 4(3–6) Food insecurity a 295(42.2) Depression score b , median (IQR) 3 (2.7–3.1) Alcohol use in the last 1 year 98 (14.0) Median social support score c , (IQR) 2.1 (1.8–3.1) Member of community support group 438 (62.7) Decision-making power d low 558 (79.8) medium 68 (9.7) high 73 (10.4) Previous maternal complications in last childbirth 365 (52.2) Perinatal death reported for last childbirth 89(12.7) History of home delivery in last birth 120 (17.2) Reported home birth attended by skilled healthcare provider 0(0) * an equivalent to about 40 USD. e those with history of childbirth a HFIAS > 8 means severe food insecurity , b this score ranges from1-48 indicating 0 as no depression , c this score ranges from 1–4, with 4 indicating high levels of social support , d this decision making dorminance score ranges from 1–12, with 12 indicating high level of decision making for the woman Patterns of home births in last pregnancy among currently pregnant women in SW Uganda One-hundred and twenty (17.2%) of women reported history of home birth in their last pregnancy (Table 2 ). Up to 65% of total home births were reported among women older than 35 years of age (n = 78). Most home births were also reported among women with primary or no education (n = 103, 85.8%), and among those earning a household income of ≤ 150,000 Ugandan Shillings per month (n = 82,68.3%) and women with 3 or more deliveries (n = 94,78.3%). Up to 95% of reported home births happened among women residing more than 5km radius from a public facility. Fifty-nine (n = 71), 65 (n = 78) and 64 (n = 77) percent of the reported home births happened among women who experienced food insecurity, poor social support and unplanned pregnancies respectively. Perinatal deaths were more (n = 33,27.5%) among women that reported home births. Table 2 Patterns and effect estimate of home births in last pregnancy among currently pregnant women in SW Uganda (N = 699) Home birth N (%) Category No Yes P value Proportion of home births 579 (82.8%) 120 (17.2%) Age categories <0.001 35years 190 (32.8%) 78 (65.0%) Education level categorized < 0.001 Primary or less 310 (53.5%) 103 (85.8%) More than primary education 269 (46.5%) 17 (14.2%) Marital status 0.436 Never married/divorced 17 (2.9%) 2 (1.7%) Married/cohabiting 562 (97.1%) 118 (98.3%) Household income/month categorized 0.002 150000= 218 (37.7%) 38 (31.7%) Parity =5 31 (5.4%) 32 (26.7%) HIV Status 0.111 Positive 50(8.6) 8(6.7) Negative 525(90.7) 107(89.1) Unknown 5(0.9) 5(4.2) Relationship power dynamic 0.155 Low 462 (79.8%) 96 (80.0%) Medium 59 (10.2%) 9 (7.5%) High 58 (10.0%) 15 (12.5%) Health facility distance 0.013 >5 km 504 (87.0%) 114 (95.0%) Within 5km 75 (13.0%) 6 (5.0%) ANC visits category 0.210 ≥5 343 (60.0%) 64 (53.3%) <5 229 (40.0%) 56 (46.7%) Food insecurity < 0.000 Food insecurity 224 (38.7%) 71 (59.2%) Food secure 355 (61.3%) 49(40.8%) Mean social support 0.002 <2 275 (47.5%) 78 (65.0%) ≥2 304 (52.5%) 42 (35.0%) Alcohol use 317 0.734 Never 499 (86.2%) 102 (85.0%) Takes 80 (13.8%) 18 (15.0%) Referent pregnancy planned 0.002 No 281 (48.5%) 77 (64.2%) Yes 298 (51.5%) 43 (35.8%) Prior childbirth complications 0.639 Yes 300 (51.8%) 65 (54.2%) No 279 (48.2%) 55 (45.8%) Perinatal death (including still birth) 150,000 Ugandan Shillings per month (OR = 1.52[1.05–2.76]; P = 0.026), >5km radius to the nearest health facility (OR = 1.12[1.03–1.23]; P = 0.011), and bad attitude about the health care system (OR = 1.41[0.99–2.11]; P = 0.047), (Table 3 ). In the multivariate model, these factors were muted. Reported history of home birth was strongly associated with older age > 35 years (AOR = 2.29[1.04–5.05]; P = 0.004), no or lower than primary education (AOR = 3.85[2.11–7.03]; P < 0.001), 3 or more deliveries (AOR = 1.62[1.37–1.92]; P < 0.019), unplanned referent pregnancy (AOR = 1.26[0.99–2.03]; P = 0.033), poor instrumental social support (AOR = 1.88[1.33–2.47]; P < 0.019), household food insecurity (AOR = 2.07[1.23–3.77]; P < 0.001). Higher adjusted odds of perinatal deaths were also reported among women that delivered from home (AOR = 2.45[1.39–4.33]; P = 0.002). Table 3 Factors associated with reported home birth in the last delivery among currently pregnant women in SW Uganda Variable Crude odds p-value AOR (95%CI) p-value Age categories 35 years 5.75(3.09–10.69) < 0.001* 2.29(1.04–5.04) 0.040* History of delivery Parity < 3 Parity ≥ 3 REF 1.85(1.61–2.12) < 0.001* 1.62(1.37–1.92) < 0.001* Education level More than primary Primary or less REF 5.26(3.07–9.01) < 0.001* 3.85(2.11–7.03) < 0.001* Marital status Never married/ Separated/divorced Married/cohabiting REF 1.79(0.41–7.83) 0.443 N/A N/A Household monthly income ≥ 150,000 5km to the health facility REF 1.12(1.03–1.23) 0.011* 1.078(0.97–1.20) 0.163 Pregnancy/childbirth beliefs Good attitude Poor attitude REF 1.41(0.98–2.11) 0.047* 1.44(0.73–1.82) 0.558 ANC visits ≥ 4 ANC visits < 4 ANC visits 1.25(0.78-2.00) REF 0.353 1.44(0.84–2.48) 0.185 Moderate to good social support ≥ 2 < 2 REF 2.46(1.852–4.87) 0.002* 1.88(1.33–2.47) 0.019* Unplanned pregnancy 1.90(1.26–2.85) 0.002* 1.26(0.99–2.03) 0.033* Perinatal deaths 3.64(2.18–5.76) < 0.001* 2.45(1.39–4.33) 0.002* Food insecurity 2.34(1.54–3.43) < 0.001* 1.85(1.23–2.77) < 0.001* Relationship power dynamics Low Medium High REF 0.870(0.567–1.335) 1.270(0.667–2.419) 0.523 0.467 NA N/A N/A N/A Discussion In this baseline analysis of a prospective cohort in rural Southwestern Uganda, home birth was more common among women who were older (≥ 35 years), had lower than primary or no formal education, had a higher parity > 3, reported unplanned pregnancies, poor instrumental social support and household food insecurity. Perinatal deaths were very high, and more common (n = 33, 27.5%; AOR = 2.45[1.39–4.33]; P = 0.002) among women who reported home births compared to facility births. No reported home birth was attended by a skilled healthcare provider. Our findings highlight two potentially modifiable protective domains namely; food security and social support networks that were strongly associated with home births and may directly influence reported perinatal outcomes. The observed associations between age, education, parity, and birthplace choice are consistent with prior work from Uganda and other LMIC settings, where limited education, older age, higher parity, and unplanned pregnancy predict lower likelihood of facility delivery and higher risk of adverse maternal and perinatal outcomes [ 5 , 50 – 52 ]. Women’s lack of information, decision-making autonomy regarding childbirth, financial independence, birth preparedness, and perceived need for maternity services are predominant challenges that contribute to delays in care-seeking, unskilled home births and pregnancy-related complications and deaths [ 3 , 8 – 10 , 33 , 53 – 57 ]. Other scholars have observed that knowledge gaps influence women’s past and future decisions to not attend ANC and pursue unskilled home births [ 9 , 12 ]. Social support as a driver of safer birth decisions aligns with literature emphasizing the role of family, friends, community health workers, and social networks in mobilizing resources needed to enable timely care-seeking, support birth planning in settings with limited financial independence and facility access [ 12 – 17 , 6 , 14 , 25 – 27 ]. The role of social support is not surprising especially in this dataset from a more rural community which largely depends on family and community networks to thrive[ 58 ]. Women in this setting are often largely dependent on their significant others for economic provisions, which together with the existing gender and traditional norms, limit women’s ability and freedom to make family or health decisions to seek skilled care [ 9 , 12 ]. Instrumental social support therefore seems to foster coping mechanisms to help women overcome barriers to formal healthcare service uptake, utilization and skilled birth [ 14 , 59 – 61 ]. Strengthening social support mechanisms and engagement could therefore bolster emotional, informational, and logistical support for pregnant women, and help enhance timely decision-making, birth planning, and linkage to skilled health care [ 28 ]. Food insecurity intersecting with pregnancy care aligns with evidence that nutritional stress and financial constraints can compromise energy, well-being, decision-making capacity, access to transportation and care [ 62 – 64 ], thereby shaping birth planning and delivery location decisions in affected communities. The role of social networks in food security is also important. Food security has been mediated through promoting existing family structure and social networks, which in turn foster financial coping mechanisms that enable women to overcome socio-economic and physical barriers to care, such as food insecurity, transportation, and provision of delegated service or food to overcome competing priorities to access healthcare [ 14 , 59 – 61 ]. Therefore, addressing household food insecurity may have downstream effects on birth planning and the capacity to timely access skilled birth care. Our study has some strengths. Although prior work in Uganda and East Africa explored individual determinants of facility-based births or perinatal outcomes, our data looks at a critical gap in integrated analyses that simultaneously considers social networks, household food security, birth planning, and perinatal outcomes, specifically in a diverse community in rural SW Uganda and among women with prior births. Contextual and health system factors in Southwestern Uganda comprises facility accessibility, affordability, perceived quality of care (facility readiness, responsiveness, respectfulness), and community readiness to utilise the available healthcare services. Socioeconomic disparities, education, financial dependence, birth preparedness and food security interact with these system factors to shape delivery decisions. In this work, we attempt to use a multivariate model to understand patterns of home birth, and its observed relationships with socio-demographic characteristics, as well as reported social support, food security, pregnancy planning, and perinatal outcomes in a prior pregnancy within a diverse geographic and socio-cultural community in SW Uganda. The combination of sociodemographic data, objective indicators (e.g., parity), and standardized scales (food insecurity, social support) allows a nuanced analysis of multiple determinants of birthplace, healthcare utilization and perinatal outcomes, which is particularly valuable in such resource-limited settings. Our study therefore documents food security as an independent structural determinant of birthplace choice after adjusting for distance, parity, education, and income, and not merely a nutrition outcome. Our study setting within Mbarara and Mitooma is also diverse (rural and peri-urban, varying levels of facility availability, geographic locations and landscapes, socio-economic profiles) that improves the relevance of findings to southwestern Uganda and potentially similar rural settings. We recruited women through community/village health teams and thus enhancing inclusivity and retention for the targeted population. Generalizability may also be possible to settings with rural and peri-urban contexts with similar health system structure and sociocultural dynamics. Noteworthy, all reported homebirths had no attendance by a skilled healthcare provider. The reported home births are recent and may have been planned/intended. The strong linkage between reported home birth and perinatal death therefore may be less confounded by delays in care-seeking or perceptions about quality of care at birth facilities, which we could not fully explore in this analysis. We used validated tools for this setting to measure household food insecurity (household food insecurity access scale) and perceived social support to enhance measurement quality. We also used baseline data from a prospective cohort within an RCT context that enhances methodological rigor and reduces some selection biases inherent to cross-sectional designs. Our study also has some limitations. We recruited women through community/village health teams and this may have accounted for higher self-reported perinatal deaths of 12.7% than the estimated national rates, excluding abortions in this population. However, other studies conducted in rural Western Uganda have also documented higher rates of institutional perinatal deaths [ 65 , 66 ]. The analysis is cross-sectional at baseline, limiting causal inference about the relationships between home birth, perinatal death, and protective factors (food security and social support). There is unmeasured confounding (e.g., cultural health beliefs, transportation accessibility, quality of care at facilities) that may bias associations. In the follow up prospective study, we will document/establish longitudinal birth outcome data beyond the baseline, and the temporal sequence between changes in social support/food security and subsequent birth outcomes. We also hope to examine how the messaging intervention and evolving household conditions affect birthplace decisions and perinatal outcomes over time in the parent trial. The association between home birth and higher perinatal mortality reinforces ongoing public health goals to increase access to and utilization of skilled birth attendance. Our data supports interventions contextually tailored to address both demand-side (awareness, autonomy, financial independence, birth preparedness) and supply-side (transport, maternity and contraceptive service availability, respectful care) barriers. Strengthening active community-/facility-based social support networks/structures and ensuring food security could also be a crucial, actionable, strategic and context-specific component of maternal-newborn health programs aimed at supporting safer birth choices in such resource-limited settings. For example, social networks could be leveraged/actively engaged to facilitate emergency transport, ANC attendance, and timely facility delivery, while food ration and provisions linked to ANC clinics or other nutrition-sensitive programs could support maternal nutrition, resilience and appropriate decision-making. Additionally, and given the association with unplanned pregnancies, and or older age, expanding access to contraception and reproductive health information and counselling remains a critical preventive strategy to reduce unintended births, improve birth planning, uptake of skilled birth services and health outcomes. Conclusion This baseline analysis from SW Uganda highlights how sociodemographic factors, social support, and household food security shape birthplace decisions and perinatal outcomes. Our findings underscore the potential for multi-faceted interventions beyond the facility that address household food insecurity and strengthen instrumental social support systems that enable women to plan and timely access skilled birth. Strengthening birth planning through family and community networks could also promote safer birth choices and ultimately improve perinatal survival in similar resource-limited settings. Future longitudinal analyses within the ongoing trial and more targeted mixed-methods research will be critical to establish causal pathways and refine scalable strategies to reduce the grim face of home births. Further evaluation of integrated interventions that couple nutrition security with maternal health services (e.g., food assistance linked to ANC and delivery planning) to determine effectiveness in increasing skilled birth attendance and improving perinatal outcomes are needed. Declarations Competing interests : All the authors declare no competing interests. Consent for publication: Consent to collect and publish data was obtained both verbally and in writing from all the study participants. Ethics approval and consent to participate : All study participants provided written informed consent before study enrolment. Permission to conduct the study was obtained from district and local community leaders. The study was reviewed and approved by the Mbarara University of Science and Technology Institutional Ethics Review Committee and the Uganda National Council for Science and Technology, Kampala, Uganda. The study was conducted in accordance with the Declaration of Helsinki. Funding: Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD111692. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Author Contribution Esther C Atukunda–study design, coordinated the research team, data collection, data analysis and drafted the manuscript, Godfrey R Mugyenyi, Elly B Atuhumuza – study design, supervised data collection, data analysis and manuscript preparation. Jessica Haberer, Peter Waiswa, Van T Nghiem, Celestino Obua, Mark J Siedner, Lynn T Matthews - Study design, supervised research group and manuscript preparation, Josephine Najjuma, Angella Musiimenta, Micheal Kanyesigye contributed to data collection, analysis and manuscript preparation. All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. Acknowledgement All mothers, village health teams and health care providers that participated in this study. Data Availability All data supporting the findings of this study are available within the paper and its Supplementary Information. References Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, Flenady V, Froen JF, Qureshi ZU, Calderwood C, et al. 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Household food insecurity access scale (HFIAS). Nutr Hosp. 2015;31(Suppl 3):272–8. Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH. The Duke-UNC Functional Social Support Questionnaire. Measurement of social support in family medicine patients. Med Care. 1988;26(7):709–23. Tsai AC, Bangsberg DR, Frongillo EA, Hunt PW, Muzoora C, Martin JN, Weiser SD. Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med. 2012;74(12):2012–9. Rogers MM, Ahluwalia IB, Melvin CL. The pregnancy risk assessment monitoring system (PRAMS). J Womens Health. 1998;7(7):799–801. Ahluwalia IB, Johnson C, Rogers M, Melvin C. Pregnancy Risk Assessment Monitoring System (PRAMS): unintended pregnancy among women having a live birth. PRAMS Working Group. J Womens Health Gend Based Med. 1999;8(5):587–9. PRAMS model surveillance protocol. [ http://www.cdc.gov/prams] Dyer S, Mokoena N, Maritz J, van der Spuy Z. Motives for parenthood among couples attending a level 3 infertility clinic in the public health sector in South Africa. Hum Reprod. 2007;23(2):352–7. Young CR, Kaida A, Kabakyenga J, Muyindike W, Musinguzi N, Martin JN, Hunt PW, Bangsberg DR, Haberer JE, Matthews LT. Prevalence and correlates of physical and sexual intimate partner violence among women living with HIV in Uganda. PLoS ONE. 2018;13(8):e0202992. Pulerwitz J, Gortmaker SL, DeJong W. Measuring sexual relationship power in HIV/STD research. Sex Roles. 2000;42(7/8):637–620. Hatcher AM, Tsai AC, Kumbakumba E, Dworkin SL, Hunt PW, Martin JN, Clark G, Bangsberg DR, Weiser SD. Sexual relationship power and depression among HIV-infected women in Rural Uganda. PLoS ONE. 2012;7(12):e49821. Siedner MJ, Tsai AC, Dworkin S, Mukiibi NF, Emenyonu NI, Hunt PW, Haberer JE, Martin JN, Bangsberg DR, Weiser SD. Sexual relationship power and malnutrition among HIV-positive women in rural Uganda. AIDS Behav. 2012;16(6):1542–8. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10. Aikpitanyi J, Okonofua F, Ntoimo LFC, Tubeuf S. Demand-side barriers to access and utilization of skilled birth care in low and lower-middle-income countries: A scoping review of evidence. Afr J Reprod Health. 2022;26(9):31–47. Tekeba B, Zegeye AF, Gebrehana DA, Tamir TT. Prevalence and Determinants of Home Delivery among Women with Easy Access to Health Facilities in Sub–Saharan African Countries: A Multi–level Mixed Effect Analysis. Ann Glob Health. 2025;91(1):5. James BC, Alemu Y, Amairo ME, Chullapant K, Uzuagu ED, Aroh CM. Predictors associated with giving birth at home among women in Ethiopia. Pan Afr Med J. 2025;50:1. Dickson KS. Women Empowerment and Skilled Birth Attendants among Women in Rural Ghana. BioMed Research International 2021, 2021:9914027. O’Neil S, Platt I, Vohra D, Pendl-Robinson E, Dehus E, Zephyrin L, Zivin K. The High Costs of Maternal Morbidity Show Why We Need Greater Investment in Maternal Health. In. https://www.commonwealthfund.org/publications/issue-briefs/2021/nov/high-costs-maternal-morbidity-need-investment-maternal-health ; 2021. Sondaal SF, Browne JL, Amoakoh-Coleman M, Borgstein A, Miltenburg AS, Verwijs M, Klipstein-Grobusch K. Assessing the Effect of mHealth Interventions in Improving Maternal and Neonatal Care in Low- and Middle-Income Countries: A Systematic Review. PLoS ONE. 2016;11(5):e0154664. Higgs ES, Goldberg AB, Labrique AB, Cook SH, Schmid C, Cole CF, Obregon RA. Understanding the role of mHealth and other media interventions for behavior change to enhance child survival and development in low- and middle-income countries: an evidence review. J Health Commun. 2014;19(Suppl 1):164–89. Lee SH, Nurmatov UB, Nwaru BI, Mukherjee M, Grant L, Pagliari C. Effectiveness of mHealth interventions for maternal, newborn and child health in low- and middle-income countries: Systematic review and meta-analysis. J Glob Health. 2016;6(1):010401. Dayaratna, Winfrey WB, Mcgreevey WP, Hardee K, Smith J, Mumford E, Sine J, Berg RC. Reproductive health interventions: which ones work and what do they cost? In: 2000 ; 2000. Tsai AC, Tomlinson M, Comulada WS, Rotheram-Borus MJ. Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa. Soc Sci Med. 2016;151:69–77. Gray JB. Social support communication in unplanned pregnancy: support types, messages, sources, and timing. J Health Commun. 2014;19(10):1196–211. Kelly JD, Hartman C, Graham J, Kallen MA, Giordano TP. Social support as a predictor of early diagnosis, linkage, retention, and adherence to HIV care: results from the steps study. J Assoc Nurses AIDS Care. 2014;25(5):405–13. Cheng ER, Luo M, Perkins M, Blake-Lamb T, Kotelchuck M, Arauz Boudreau A, Taveras EM. Household food insecurity is associated with obesogenic health behaviours among a low-income cohort of pregnant women in Boston, MA. Public Health Nutr. 2023;26(5):943–51. Roy D, Zulfiqar F, Tsusaka TW, Datta A. Household food insecurity and dietary diversity of women of reproductive age among smallholder farming households in northwest Bangladesh. Ecol Food Nutr. 2022;61(4):460–83. Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP, Suchdev PS, Ezzati M, Rohner F, Flaxman SR, et al. National, regional, and global estimates of anaemia by severity in women and children for 2000-19: a pooled analysis of population-representative data. Lancet Glob Health. 2022;10(5):e627–39. Egesa WI, Odong RJ, Kalubi P, Ortiz Yamile EA, Atwine D, Turyasiima M, Kiconco G, Maren MB, Nduwimana M, Ssebuufu R. 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Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 May, 2026 Reviews received at journal 26 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers agreed at journal 12 Mar, 2026 Reviewers invited by journal 05 Mar, 2026 Editor invited by journal 06 Feb, 2026 Editor assigned by journal 03 Feb, 2026 Submission checks completed at journal 03 Feb, 2026 First submitted to journal 23 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8681001","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":602420750,"identity":"c28c78b2-e7dc-49ab-8383-f98ae1fcd899","order_by":0,"name":"Esther C 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University","correspondingAuthor":false,"prefix":"","firstName":"Mark","middleName":"J","lastName":"Siedner","suffix":""},{"id":602420761,"identity":"91b208db-b2c1-4483-8eaf-c3753946a8a6","order_by":11,"name":"Lynn T Matthews","email":"","orcid":"","institution":"Harvard University","correspondingAuthor":false,"prefix":"","firstName":"Lynn","middleName":"T","lastName":"Matthews","suffix":""}],"badges":[],"createdAt":"2026-01-23 16:09:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8681001/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8681001/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104780511,"identity":"dcb0f141-480a-40bf-a5f1-ece6d5344efd","added_by":"auto","created_at":"2026-03-17 07:53:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1104573,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8681001/v1/33e1e99b-5624-421d-8c82-05fc22b0ec4c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The grim face of home births, perinatal deaths, and the protective role of food security and social support among pregnant women in Southwestern Uganda","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eOver 99% of infant deaths occur in low and middle-income countries (LMICs) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Persistently high maternal mortality rates in LMICs are partly attributed to challenges accessing care, poor antenatal care (ANC) attendance, with undiagnosed or poorly managed pregnancy-related complications from direct or indirect causes[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Uganda has long faced high maternal (189/100,000), and perinatal (38 deaths/1000 births) mortality with up to 30% of births occurring outside formal health facilities [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The factors driving this trend are complex. Geographic, financial, and sociocultural barriers such as distance to health facilities, transport costs, user fees shape home delivery decisions, and contribute to increased risks of childbirth complications and preventable obstetric mortality [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Women\u0026rsquo;s lack of information, social support, financial independence for emotional and economic provisions, decision-making autonomy regarding childbirth, birth preparedness, and perceived need for responsive and respectful maternity care services are important challenges to utilizing available maternity services in these settings [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Women at risk of unskilled home births need relevant and context specific strategies to encourage ANC attendance and skilled delivery [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStrong social support networks such as family, friends, relatives, community health workers and networks, play a critical role in providing emotional, informational, physical and financial resources that could facilitate timely decision making needed to overcome critical \"delays\" in referrals and care-seeking during pregnancy and delivery [\u003cspan additionalcitationids=\"CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Social support can shape maternal health behaviors and decisions about where to deliver, facilitate health service uptake, birth planning, buffer economic shocks and accelerate timely help-seeking and or access to facility delivery[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Poor networks and social capital have been linked to greater reliance on home-based or traditional approaches during pregnancy and delivery [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Social network involvement therefore not only addresses individual, but also family and societal/ community-level barriers to care in a setting with modest availability of health centers providing needed services [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFood insecurity and poor nutrition during pregnancy may lead to anemia, infections, hypertensive/metabolic disorders, low birthweight and increased risk of maternal and neonatal complications [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In resource-limited settings, food insecurity often coexists with poverty and may exacerbate vulnerability, constrain families\u0026rsquo; ability to transport to facilities or pay for services [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], particularly in rural Southwest Uganda where agriculturally dependent communities predominate [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Whereas the literature highlights the valuable role of support networks, the specific influence of food security on the choices and outcomes related to home births and perinatal deaths in Uganda remains a critical gap in the literature. Food insecurity may affect birth planning and access to skilled care partly through direct impacts on maternal energy in late pregnancy but also informing decisions about when and where to deliver, particularly where transport and service costs compete with other urgent household needs. Some reports further suggest that adequate nutrition supports maternal resilience and confidence, that may influence birth planning, care-seeking, adherence to antenatal care, capacity to participate in recommended maternal-newborn practices and birth place decisions[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is limited evidence from rural Uganda and similar settings that examines: (i) the socio-cultural drivers of home birth, (ii) the sub categories of women associated with home birth, (iii) how home births correlate with perinatal mortality in a community-recruited population, and (iv) how social support networks and household food security influence birthplace choices and perinatal outcomes (socioeconomic determinants). We assess this matrix from a diverse mix of rural and peri-urban communities of southwestern Uganda with varying levels of health facility availability, transportation infrastructure, sociocultural and economic diversity to better understand the contributors to home births and motivate interventions which might address them.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eWe analyzed baseline data collected from pregnant women who had had at least one prior birth and enrolled in a randomized controlled trial in southwestern Uganda. The parent trial aims to evaluate the effect of a messaging intervention in improving utilization of available maternity care services, and ultimately reduce maternal and perinatal mortality (NCT05940831)[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUganda\u0026rsquo;s public health system is organized into seven tiers with national and regional referral hospitals, general district hospitals and four levels of community health centers (HC). Staffing and available services vary across the four levels: HCIII carry out vaginal deliveries, whereas HCI and HCII serve as low resource referral units. HCIVs and hospitals conduct normal and caesarean deliveries, and have ambulances and blood transfusion services[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Private providers operate in parallel to the public health system to provide maternal healthcare. Mbarara and Mitooma districts within Southwestern Uganda, encompass rural, peri-urban, and smaller urban centers to capture diversity in access to health services and food security conditions. These two sites were selected for this research based on their geographic, socio-cultural, and institutional diversity, and high maternal mortality and morbidity data. Both districts have publicly funded and operated facilities with active maternity care units. The local economy of these two districts is also largely based on subsistence agriculture, with both food and water insecurity being common [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Maternity services, including delivery, are largely provided free of charge through public HCs.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Recruitment\u003c/h3\u003e\n\u003cp\u003eWomen were eligible if they were pregnant at \u0026lt;\u0026thinsp;20 weeks of amenorrhoea (determined by last normal menstrual period or ultrasound scan where available) had not yet presented for ANC and resident of areas within a 10 km radius of publicly funded maternity centers in Mbarara and Mitooma districts. Eligible women were aged 15\u0026ndash;49 years, with at least one prior live birth. Participants were asked to identify two individuals from their existing social support network with whom they have had stable, long-term relationships and believe they would be available to help them during the pregnancy and study follow-up period. Women unable to complete baseline interview (e.g., severe cognitive impairment) or who had language barriers not addressable by interpreters were excluded. Community/Village Health Teams (C/VHTs) notified study research assistants about potentially eligible participants. Trained research assistants (RAs) approached women referred by C/VHTs and obtained voluntary written informed consent from all eligible participants. All consenting participants gave written informed consent, or for those who could not write, a thumbprint was made on the consent form.\u003c/p\u003e\n\u003ch3\u003eStudy Groups\u003c/h3\u003e\n\u003cp\u003eWomen were screened for eligibility and equally randomized 1:1 into the intervention arm (messaging intervention) and standard of care (control group) between November 2023 and July 2025. These women are being followed until delivery. All participants completed baseline interviewer-administered interviews. Interviews were conducted by four trained research assistants fluent in English and the main local language in a private office space. Each interview took about 45\u0026ndash;60 min. Data was collected electronically. A transport refund of \u003cspan\u003e$\u003c/span\u003e5 was given on each visit.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eA structured face-to-face questionnaire was completed at enrolment to collect information on socio-demographics, health [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], pregnancy planning, reproductive history, partnership dynamics (e.g. HIV serostatus/ disclosure, partner HIV-serostatus), decision making [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], HIV and stigma [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and alcohol use in the last 12 months [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] due to its association with health outcomes. We collected reported the distance to nearest health facility, availability of midwives, history of home/facility birth, community support for alternative birthing choices, and relationships with health care providers. We measured food insecurity using the Household Food Insecurity Access Scale (HFIAS) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. We adopted and measured social support using a version of the Duke-UNC Functional Social Support Scale [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], a tool that has been widely used in Uganda [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Health, pregnancy, childbirth beliefs, knowledge, risk awareness, need for skilled delivery and childbirth practices were assessed as per previous studies in the same setting [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. We adopted the 6 items used in Uganda to assess pregnancy risk assessment, personal and partner pregnancy desires [\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], 18 questions/statements reflecting 6 parenthood motives [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. We assessed gender-based violence [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], and relationship power [\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e] given its relationship with home births in Uganda [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These survey data included the self-reported date and location of the previous birth, whether there was a skilled birth attendant present, mode of delivery (ie. vaginal vs C-section delivery), birth outcome; including preterm birth, still births, newborn deaths.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eWe describe demographic and clinical data for the cohort using standard descriptive statistics. We assessed the prevalence and covariates of home birth delivery for the last pregnancy. The Household Food Insecurity Access Scale (HFIAS) was calculated as recommended [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Social support received by women was measured using the Duke-UNC Functional Social Support Questionnaire [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The primary outcome of interest was home birth delivery. Univariable logistic regression was used to assess unadjusted associations between covariates and home birth, expressed using crude odds ratio and 95% confidence intervals. We utilized Andersen\u0026rsquo;s Healthcare Utilization Model [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] to pick covariates. Variables with p value\u0026thinsp;\u0026le;\u0026thinsp;0.20 in unadjusted analyses were considered for inclusion in a multivariable logistic regression analysis. Variables examined in the unadjusted model found to be collinear were selectively excluded from the multivariate models. Analysis to establish the effect on perinatal mortality by reported home birth was also done. Statistical significance was defined at the level of p\u0026thinsp;\u0026le;\u0026thinsp;0.05. All data analyses were performed using STATA version 17.0 (Statacorp, College Station, Texas, USA).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eHuman Ethics and Consent to Participate declarations missing\u003c/h2\u003e \u003cp\u003e This study was approved by the Institutional Review Council of Mbarara University of Science and Technology (MUST-2022-631) and Uganda National Council of Science and Technology (HS3366ES), and registered with clinicaltrials.gov (NTC05940831). Study site administrative permission was obtained. We obtained informed consent from all participants, including emancipated minors under 18 years of age as per Uganda\u0026rsquo;s regulations.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eA total of 1206 women were screened for eligibility, 824 women were eligible and enrolled (191 had already initiated ANC visits, 153 had gestation age\u0026thinsp;\u0026gt;\u0026thinsp;20 weeks, 38 were not interested in the study). Out of the 824, 699 reported a previous childbirth and were included in this analysis. The mean maternal age was 27.8 (standard deviation [SD] 6.3) years. Women who reported more than primary education were 40.9% (n\u0026thinsp;=\u0026thinsp;286). The median gestational age was 14 (IQR\u0026thinsp;=\u0026thinsp;12\u0026ndash;17) weeks, up to 97% were married or cohabiting (n\u0026thinsp;=\u0026thinsp;680), 67 (9.6%) reported to be HIV positive, mostly disclosed (n\u0026thinsp;=\u0026thinsp;60, 8.6%) and antenatal attendance\u0026thinsp;\u0026gt;\u0026thinsp;4 visits in the last pregnancy was approximately 59% (n\u0026thinsp;=\u0026thinsp;407). Only 256(36.6%) reported household income\u0026thinsp;\u0026gt;\u0026thinsp;150,000 Ugandan Shilling (~\u0026thinsp;40 USD) per month. Vaginal delivery in last pregnancy was reported to be about 78% (n\u0026thinsp;=\u0026thinsp;616), 341(48.8%) of previous pregnancy was planned. The average birth interval and children\u0026thinsp;\u0026lt;\u0026thinsp;18 years of age in household were reported to be 11 (IQR\u0026thinsp;=\u0026thinsp;8\u0026ndash;21) months and 2 (IQR\u0026thinsp;=\u0026thinsp;1\u0026ndash;3) respectively. Up to 80% (n\u0026thinsp;=\u0026thinsp;558) of women reported low decision-making power, with most women residing averagely within 4km radius to a publicly funded health facility (IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;6). About 42.2% (n\u0026thinsp;=\u0026thinsp;295) experienced severe food insecurity, and alcohol consumption in the past 12 months was reported by 14% (n\u0026thinsp;=\u0026thinsp;98). Half of participants (49.5%) received moderate to adequate social support (median score\u0026thinsp;=\u0026thinsp;2.1[IQR\u0026thinsp;=\u0026thinsp;1.8\u0026ndash;3.1]). Eighty-nine (12.7%) of women reported history of perinatal death in their last pregnancy. No reported home birth was attended by a skilled healthcare provider. Other baseline characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline demographic and clinical characteristics of pregnant women with a recent childbirth in SW Uganda, N\u0026thinsp;=\u0026thinsp;699\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean(SD) or Median(IQR) or n(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age (completed years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.8 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation attainment greater than primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e286 (40.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian weeks of gestation period (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (12\u0026ndash;17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried/cohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e680 (97.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (9.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e622 (89.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV Disclosure to spouse/partner (among those reporting positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (89.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy disclosure to spouse/partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e685 (98.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e264 (37.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e147 (21.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139 (19.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (12.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (9.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANC visits\u0026thinsp;\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e407 (58.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold income\u0026thinsp;\u0026gt;\u0026thinsp;150000\u0026thinsp;=\u0026thinsp;Shs* per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e256 (36.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal mode of delivery for last pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e616 (78.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLast pregnancy was planned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e341 (48.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent pregnancy planned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e412 (58.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage birth interval from previous to current pregnancy (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (8\u0026ndash;21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChildren\u0026thinsp;\u0026lt;\u0026thinsp;18 years in household, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1,3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance to a publicly funded health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(3\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood insecurity\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e295(42.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression score\u003csup\u003eb\u003c/sup\u003e, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.7\u0026ndash;3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol use in the last 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (14.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian social support score\u003csup\u003ec\u003c/sup\u003e, (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1 (1.8\u0026ndash;3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMember of community support group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e438 (62.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecision-making power\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e558 (79.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (9.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (10.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious maternal complications in last childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e365 (52.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerinatal death reported for last childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89(12.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of home delivery in last birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120 (17.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReported home birth attended by skilled healthcare provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e\u003cem\u003e*\u003c/em\u003e\u003c/sup\u003e\u003cem\u003ean equivalent to about 40 USD.\u003c/em\u003e \u003csup\u003e\u003cem\u003ee\u003c/em\u003e\u003c/sup\u003e \u003cem\u003ethose with history of childbirth\u003c/em\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e \u003cem\u003eHFIAS\u0026thinsp;\u0026gt;\u0026thinsp;8 means severe food insecurity\u003c/em\u003e, \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e \u003cem\u003ethis score ranges from1-48 indicating 0 as no depression\u003c/em\u003e, \u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e \u003cem\u003ethis score ranges from 1\u0026ndash;4, with 4 indicating high levels of social support\u003c/em\u003e, \u003csup\u003e\u003cem\u003ed\u003c/em\u003e\u003c/sup\u003e \u003cem\u003ethis decision making dorminance score ranges from 1\u0026ndash;12, with 12 indicating high level of decision making for the woman\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePatterns of home births in last pregnancy among currently pregnant women in SW Uganda\u003c/h2\u003e \u003cp\u003eOne-hundred and twenty (17.2%) of women reported history of home birth in their last pregnancy (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Up to 65% of total home births were reported among women older than 35 years of age (n\u0026thinsp;=\u0026thinsp;78). Most home births were also reported among women with primary or no education (n\u0026thinsp;=\u0026thinsp;103, 85.8%), and among those earning a household income of \u0026le;\u0026thinsp;150,000 Ugandan Shillings per month (n\u0026thinsp;=\u0026thinsp;82,68.3%) and women with 3 or more deliveries (n\u0026thinsp;=\u0026thinsp;94,78.3%). Up to 95% of reported home births happened among women residing more than 5km radius from a public facility. Fifty-nine (n\u0026thinsp;=\u0026thinsp;71), 65 (n\u0026thinsp;=\u0026thinsp;78) and 64 (n\u0026thinsp;=\u0026thinsp;77) percent of the reported home births happened among women who experienced food insecurity, poor social support and unplanned pregnancies respectively. Perinatal deaths were more (n\u0026thinsp;=\u0026thinsp;33,27.5%) among women that reported home births.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatterns and effect estimate of home births in last pregnancy among currently pregnant women in SW Uganda (N\u0026thinsp;=\u0026thinsp;699)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eHome birth N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of home births\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e579 (82.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge categories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;25 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e182 (31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e207 (35.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;35years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e190 (32.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (65.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level categorized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e310 (53.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (85.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than primary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e269 (46.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.436\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married/divorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried/cohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e562 (97.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118 (98.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold income/month categorized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;=150,000=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e361 (62.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (68.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;150000=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e218 (37.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e255 (44.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103 (17.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50(8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e525(90.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107(89.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationship power dynamic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e462 (79.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (10.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth facility distance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;5 km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e504 (87.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (95.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithin 5km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (13.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANC visits category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e343 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (53.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e229 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (46.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e224 (38.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (59.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood secure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e355 (61.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(40.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean social support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e275 (47.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (65.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e304 (52.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e499 (86.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (85.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTakes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferent pregnancy planned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e281 (48.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (64.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e298 (51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (35.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior childbirth complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e300 (51.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (54.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e279 (48.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (45.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerinatal death (including still birth)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e523 (90.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (72.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn bivariate analyses, several factors were associated with higher odds of home births in their last pregnancy including household income\u0026thinsp;\u0026gt;\u0026thinsp;150,000 Ugandan Shillings per month (OR\u0026thinsp;=\u0026thinsp;1.52[1.05\u0026ndash;2.76]; P\u0026thinsp;=\u0026thinsp;0.026), \u0026gt;5km radius to the nearest health facility (OR\u0026thinsp;=\u0026thinsp;1.12[1.03\u0026ndash;1.23]; P\u0026thinsp;=\u0026thinsp;0.011), and bad attitude about the health care system (OR\u0026thinsp;=\u0026thinsp;1.41[0.99\u0026ndash;2.11]; P\u0026thinsp;=\u0026thinsp;0.047), (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In the multivariate model, these factors were muted. Reported history of home birth was strongly associated with older age\u0026thinsp;\u0026gt;\u0026thinsp;35 years (AOR\u0026thinsp;=\u0026thinsp;2.29[1.04\u0026ndash;5.05]; P\u0026thinsp;=\u0026thinsp;0.004), no or lower than primary education (AOR\u0026thinsp;=\u0026thinsp;3.85[2.11\u0026ndash;7.03]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), 3 or more deliveries (AOR\u0026thinsp;=\u0026thinsp;1.62[1.37\u0026ndash;1.92]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.019), unplanned referent pregnancy (AOR\u0026thinsp;=\u0026thinsp;1.26[0.99\u0026ndash;2.03]; P\u0026thinsp;=\u0026thinsp;0.033), poor instrumental social support (AOR\u0026thinsp;=\u0026thinsp;1.88[1.33\u0026ndash;2.47]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.019), household food insecurity (AOR\u0026thinsp;=\u0026thinsp;2.07[1.23\u0026ndash;3.77]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Higher adjusted odds of perinatal deaths were also reported among women that delivered from home (AOR\u0026thinsp;=\u0026thinsp;2.45[1.39\u0026ndash;4.33]; P\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eFactors associated with reported home birth in the last delivery among currently pregnant women in SW Uganda\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude odds\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge categories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.96(1.00-3.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.054\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.81(0.86\u0026ndash;3.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.75(3.09\u0026ndash;10.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.29(1.04\u0026ndash;5.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.040*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of delivery\u003c/p\u003e \u003cp\u003eParity\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003cp\u003eParity\u0026thinsp;\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003cp\u003e1.85(1.61\u0026ndash;2.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.62(1.37\u0026ndash;1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003cp\u003eMore than primary\u003c/p\u003e \u003cp\u003ePrimary or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003cp\u003e5.26(3.07\u0026ndash;9.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.85(2.11\u0026ndash;7.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003cp\u003eNever married/ Separated/divorced\u003c/p\u003e \u003cp\u003eMarried/cohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003cp\u003e1.79(0.41\u0026ndash;7.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold monthly income\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;150,000\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;150,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003cp\u003e1.52(1.046\u0026ndash;2.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.026*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02(0.72\u0026ndash;1.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance to a publicly funded facility\u003c/p\u003e \u003cp\u003e\u0026le;\u0026thinsp;5km to the health facility\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5km to the health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003cp\u003e1.12(1.03\u0026ndash;1.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.011*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.078(0.97\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy/childbirth beliefs\u003c/p\u003e \u003cp\u003eGood attitude\u003c/p\u003e \u003cp\u003ePoor attitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003cp\u003e1.41(0.98\u0026ndash;2.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.047*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.44(0.73\u0026ndash;1.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eANC visits\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4 ANC visits\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4 ANC visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25(0.78-2.00)\u003c/p\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.44(0.84\u0026ndash;2.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate to good social support\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003cp\u003e2.46(1.852\u0026ndash;4.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.88(1.33\u0026ndash;2.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.019*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnplanned pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.90(1.26\u0026ndash;2.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.26(0.99\u0026ndash;2.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.033*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerinatal deaths\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.64(2.18\u0026ndash;5.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.45(1.39\u0026ndash;4.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood insecurity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.34(1.54\u0026ndash;3.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.85(1.23\u0026ndash;2.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationship power dynamics\u003c/p\u003e \u003cp\u003eLow\u003c/p\u003e \u003cp\u003eMedium\u003c/p\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003cp\u003e0.870(0.567\u0026ndash;1.335)\u003c/p\u003e \u003cp\u003e1.270(0.667\u0026ndash;2.419)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.523\u003c/p\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this baseline analysis of a prospective cohort in rural Southwestern Uganda, home birth was more common among women who were older (\u0026ge;\u0026thinsp;35 years), had lower than primary or no formal education, had a higher parity\u0026thinsp;\u0026gt;\u0026thinsp;3, reported unplanned pregnancies, poor instrumental social support and household food insecurity. Perinatal deaths were very high, and more common (n\u0026thinsp;=\u0026thinsp;33, 27.5%; AOR\u0026thinsp;=\u0026thinsp;2.45[1.39\u0026ndash;4.33]; P\u0026thinsp;=\u0026thinsp;0.002) among women who reported home births compared to facility births. No reported home birth was attended by a skilled healthcare provider. Our findings highlight two potentially modifiable protective domains namely; food security and social support networks that were strongly associated with home births and may directly influence reported perinatal outcomes.\u003c/p\u003e \u003cp\u003eThe observed associations between age, education, parity, and birthplace choice are consistent with prior work from Uganda and other LMIC settings, where limited education, older age, higher parity, and unplanned pregnancy predict lower likelihood of facility delivery and higher risk of adverse maternal and perinatal outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR51\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Women\u0026rsquo;s lack of information, decision-making autonomy regarding childbirth, financial independence, birth preparedness, and perceived need for maternity services are predominant challenges that contribute to delays in care-seeking, unskilled home births and pregnancy-related complications and deaths [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan additionalcitationids=\"CR54 CR55 CR56\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Other scholars have observed that knowledge gaps influence women\u0026rsquo;s past and future decisions to not attend ANC and pursue unskilled home births [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSocial support as a driver of safer birth decisions aligns with literature emphasizing the role of family, friends, community health workers, and social networks in mobilizing resources needed to enable timely care-seeking, support birth planning in settings with limited financial independence and facility access [\u003cspan additionalcitationids=\"CR13 CR14 CR15 CR16\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The role of social support is not surprising especially in this dataset from a more rural community which largely depends on family and community networks to thrive[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. Women in this setting are often largely dependent on their significant others for economic provisions, which together with the existing gender and traditional norms, limit women\u0026rsquo;s ability and freedom to make family or health decisions to seek skilled care [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Instrumental social support therefore seems to foster coping mechanisms to help women overcome barriers to formal healthcare service uptake, utilization and skilled birth [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR60\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Strengthening social support mechanisms and engagement could therefore bolster emotional, informational, and logistical support for pregnant women, and help enhance timely decision-making, birth planning, and linkage to skilled health care [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFood insecurity intersecting with pregnancy care aligns with evidence that nutritional stress and financial constraints can compromise energy, well-being, decision-making capacity, access to transportation and care [\u003cspan additionalcitationids=\"CR63\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e], thereby shaping birth planning and delivery location decisions in affected communities. The role of social networks in food security is also important. Food security has been mediated through promoting existing family structure and social networks, which in turn foster financial coping mechanisms that enable women to overcome socio-economic and physical barriers to care, such as food insecurity, transportation, and provision of delegated service or food to overcome competing priorities to access healthcare [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR60\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Therefore, addressing household food insecurity may have downstream effects on birth planning and the capacity to timely access skilled birth care.\u003c/p\u003e \u003cp\u003eOur study has some strengths. Although prior work in Uganda and East Africa explored individual determinants of facility-based births or perinatal outcomes, our data looks at a critical gap in integrated analyses that simultaneously considers social networks, household food security, birth planning, and perinatal outcomes, specifically in a diverse community in rural SW Uganda and among women with prior births. Contextual and health system factors in Southwestern Uganda comprises facility accessibility, affordability, perceived quality of care (facility readiness, responsiveness, respectfulness), and community readiness to utilise the available healthcare services. Socioeconomic disparities, education, financial dependence, birth preparedness and food security interact with these system factors to shape delivery decisions. In this work, we attempt to use a multivariate model to understand patterns of home birth, and its observed relationships with socio-demographic characteristics, as well as reported social support, food security, pregnancy planning, and perinatal outcomes in a prior pregnancy within a diverse geographic and socio-cultural community in SW Uganda. The combination of sociodemographic data, objective indicators (e.g., parity), and standardized scales (food insecurity, social support) allows a nuanced analysis of multiple determinants of birthplace, healthcare utilization and perinatal outcomes, which is particularly valuable in such resource-limited settings. Our study therefore documents food security as an independent structural determinant of birthplace choice after adjusting for distance, parity, education, and income, and not merely a nutrition outcome. Our study setting within Mbarara and Mitooma is also diverse (rural and peri-urban, varying levels of facility availability, geographic locations and landscapes, socio-economic profiles) that improves the relevance of findings to southwestern Uganda and potentially similar rural settings. We recruited women through community/village health teams and thus enhancing inclusivity and retention for the targeted population. Generalizability may also be possible to settings with rural and peri-urban contexts with similar health system structure and sociocultural dynamics.\u003c/p\u003e \u003cp\u003eNoteworthy, all reported homebirths had no attendance by a skilled healthcare provider. The reported home births are recent and may have been planned/intended. The strong linkage between reported home birth and perinatal death therefore may be less confounded by delays in care-seeking or perceptions about quality of care at birth facilities, which we could not fully explore in this analysis. We used validated tools for this setting to measure household food insecurity (household food insecurity access scale) and perceived social support to enhance measurement quality. We also used baseline data from a prospective cohort within an RCT context that enhances methodological rigor and reduces some selection biases inherent to cross-sectional designs.\u003c/p\u003e \u003cp\u003eOur study also has some limitations. We recruited women through community/village health teams and this may have accounted for higher self-reported perinatal deaths of 12.7% than the estimated national rates, excluding abortions in this population. However, other studies conducted in rural Western Uganda have also documented higher rates of institutional perinatal deaths [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. The analysis is cross-sectional at baseline, limiting causal inference about the relationships between home birth, perinatal death, and protective factors (food security and social support). There is unmeasured confounding (e.g., cultural health beliefs, transportation accessibility, quality of care at facilities) that may bias associations. In the follow up prospective study, we will document/establish longitudinal birth outcome data beyond the baseline, and the temporal sequence between changes in social support/food security and subsequent birth outcomes. We also hope to examine how the messaging intervention and evolving household conditions affect birthplace decisions and perinatal outcomes over time in the parent trial.\u003c/p\u003e \u003cp\u003eThe association between home birth and higher perinatal mortality reinforces ongoing public health goals to increase access to and utilization of skilled birth attendance. Our data supports interventions contextually tailored to address both demand-side (awareness, autonomy, financial independence, birth preparedness) and supply-side (transport, maternity and contraceptive service availability, respectful care) barriers. Strengthening active community-/facility-based social support networks/structures and ensuring food security could also be a crucial, actionable, strategic and context-specific component of maternal-newborn health programs aimed at supporting safer birth choices in such resource-limited settings. For example, social networks could be leveraged/actively engaged to facilitate emergency transport, ANC attendance, and timely facility delivery, while food ration and provisions linked to ANC clinics or other nutrition-sensitive programs could support maternal nutrition, resilience and appropriate decision-making. Additionally, and given the association with unplanned pregnancies, and or older age, expanding access to contraception and reproductive health information and counselling remains a critical preventive strategy to reduce unintended births, improve birth planning, uptake of skilled birth services and health outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis baseline analysis from SW Uganda highlights how sociodemographic factors, social support, and household food security shape birthplace decisions and perinatal outcomes. Our findings underscore the potential for multi-faceted interventions beyond the facility that address household food insecurity and strengthen instrumental social support systems that enable women to plan and timely access skilled birth. Strengthening birth planning through family and community networks could also promote safer birth choices and ultimately improve perinatal survival in similar resource-limited settings. Future longitudinal analyses within the ongoing trial and more targeted mixed-methods research will be critical to establish causal pathways and refine scalable strategies to reduce the grim face of home births. Further evaluation of integrated interventions that couple nutrition security with maternal health services (e.g., food assistance linked to ANC and delivery planning) to determine effectiveness in increasing skilled birth attendance and improving perinatal outcomes are needed.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003e \u003cb\u003eCompeting interests\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eAll the authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eConsent to collect and publish data was obtained both verbally and in writing from all the study participants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e \u003cb\u003eEthics approval and consent to participate\u003c/b\u003e:\u003c/strong\u003e \u003cp\u003e All study participants provided written informed consent before study enrolment. Permission to conduct the study was obtained from district and local community leaders. The study was reviewed and approved by the Mbarara University of Science and Technology Institutional Ethics Review Committee and the Uganda National Council for Science and Technology, Kampala, Uganda. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eResearch reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health \u0026amp; Human Development of the National Institutes of Health under Award Number R01HD111692. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEsther C Atukunda\u0026ndash;study design, coordinated the research team, data collection, data analysis and drafted the manuscript, Godfrey R Mugyenyi, Elly B Atuhumuza \u0026ndash; study design, supervised data collection, data analysis and manuscript preparation. Jessica Haberer, Peter Waiswa, Van T Nghiem, Celestino Obua, Mark J Siedner, Lynn T Matthews - Study design, supervised research group and manuscript preparation, Josephine Najjuma, Angella Musiimenta, Micheal Kanyesigye contributed to data collection, analysis and manuscript preparation. All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eAll mothers, village health teams and health care providers that participated in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data supporting the findings of this study are available within the paper and its Supplementary Information.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, Flenady V, Froen JF, Qureshi ZU, Calderwood C, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. 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Lancet Glob Health. 2022;10(5):e627\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEgesa WI, Odong RJ, Kalubi P, Ortiz Yamile EA, Atwine D, Turyasiima M, Kiconco G, Maren MB, Nduwimana M, Ssebuufu R. Preterm Neonatal Mortality and Its Determinants at a Tertiary Hospital in Western Uganda: A Prospective Cohort Study. Pediatr Health Med Ther. 2020;11:409\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoyer CA, Kolars CK, Oppong SA, Bakari A, Bell A, Busingye P. Predictors of stillbirths and neonatal deaths in rural western Uganda. Int J Gynaecol Obstet. 2016;134(2):190\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"birth choices, home birth, maternal care access, social support, food security, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-8681001/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8681001/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eUp to 30% of Uganda\u0026rsquo;s births occur outside formal health facilities, where there are higher risks of maternal and perinatal deaths. Strategies to encourage facility-based delivery are needed. In this paper, we study patterns of home births and perinatal deaths and evaluate factors that could mitigate their risk among pregnant women in southwestern Uganda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe analyzed baseline data from a prospective cohort of pregnant women in rural Uganda. Pregnant women were recruited through community health teams and networks. Enrolled women completed an interviewer-administered questionnaire to collect data on sociodemographic characteristics, reproductive history, prior birth and pregnancy outcomes, household food security, and perceived social support. We used multivariable logistic regression to assess factors associated with home birth, its association with perinatal deaths, and explore the protective roles of sociodemographic, food security and social support.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 699 women enrolled, mean age was 27.8 (standard deviation [SD] 6.3) years, median gestational age was 14 (IQR\u0026thinsp;=\u0026thinsp;12\u0026ndash;17) weeks, 67 (9.6%) reported to be HIV positive and 341 (48.8%) of previous pregnancies were planned. Only 256 (36.6%) reported a monthly household income\u0026thinsp;\u0026gt;\u0026thinsp;150,000UGX (approximately 40USD/month). One-hundred and twenty (17.2%) women reported a home birth in their last pregnancy. Eighty-nine (12.7%) women reported a history of perinatal death in their last pregnancy. History of home birth was associated with age\u0026thinsp;\u0026gt;\u0026thinsp;35 years (AOR\u0026thinsp;=\u0026thinsp;2.29[1.04\u0026ndash;5.05]; P\u0026thinsp;=\u0026thinsp;0.004), no or lower than primary education (AOR\u0026thinsp;=\u0026thinsp;3.85[2.11\u0026ndash;7.03]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), parity\u0026thinsp;\u0026gt;\u0026thinsp;3 (AOR\u0026thinsp;=\u0026thinsp;1.62[1.37\u0026ndash;1.92]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.019), unplanned prior pregnancy (AOR\u0026thinsp;=\u0026thinsp;1.26[1.01\u0026ndash;2.03]; P\u0026thinsp;=\u0026thinsp;0.033), poor instrumental social support (AOR\u0026thinsp;=\u0026thinsp;1.88[1.33\u0026ndash;2.47]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.019), and household food insecurity (AOR\u0026thinsp;=\u0026thinsp;1.87[1.23\u0026ndash;2.77]; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Higher adjusted odds of perinatal deaths were reported among women that delivered from home (AOR\u0026thinsp;=\u0026thinsp;2.45[1.39\u0026ndash;4.33; P\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWe observed higher rates of home births among older women, those with low educational attainment, and those with low social support and household food insecurity. Perinatal deaths were more common among women who delivered from home. Scalable strategies are needed to support safer birth choices and reduce maternal and neonatal deaths in such resource-limited settings.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eThis trial was fully registered on 10th July 2023 on ClinicalTrials.gov NCT05940831 https//clinicaltrials.gov/study/NCT05940831\u003c/p\u003e","manuscriptTitle":"The grim face of home births, perinatal deaths, and the protective role of food security and social support among pregnant women in Southwestern Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-11 18:20:24","doi":"10.21203/rs.3.rs-8681001/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-08T18:25:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-26T09:09:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T09:27:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162334135490703411985984491893214847563","date":"2026-03-16T18:07:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"276023590491659294698180654331000987500","date":"2026-03-12T12:38:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-05T15:38:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-06T15:58:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-04T03:40:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-04T03:39:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-01-23T15:56:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"543af901-5921-49f3-8cb6-c8d9ecb223c7","owner":[],"postedDate":"March 11th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-08T18:25:53+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T14:11:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-11 18:20:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8681001","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8681001","identity":"rs-8681001","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}