The study published in BMJ Global Health and authored by Nasir Umar and others is based on a discrete choice experiment following a comprehensive literature review to identify attributes of care. 426 women who had a facility birth experience were asked to choose between two hypothetical health facilities or home birth for a future delivery.

Results showed that the most important factor influencing their choice of place of delivery  was good health system conditions. This was followed by an absence of sexual abuse, absence of physical and verbal abuse, poor facility culture, including an unclean birth environment, unclear user fee and no privacy had the most negative impact on preferences for facility-based birth.

Women’s poor experience of a facility-based birth experience has a significant impact on their preference for place of delivery. Achieving universal health coverage will require efforts toward addressing poor facility birth experiences and promoting respectful maternity care, to ensure women want to access the services available.