Determinants of non-utilization of health facilities for childbirth in Papua New Guinea: Evidence from the demographic and health survey.

BACKGROUND: Health facility-based childbirth services are essential for reducing maternal and neonatal mortality. Yet, these services remain underutilized in many low- and middle-income countries (LMICs), including Papua New Guinea (PNG), where birthing at home or in village settings continue to predominate. This study investigated the determinants of non-utilization of health facilities for childbirth among women in PNG. METHODS: Data from a weighted sample of 6,432 women using the 2016-2018 PNG Demographic and Health Survey (DHS) were analyzed. Descriptive statistics and multivariate logistic regression analyses were conducted to determine the factors associated with the non-utilization of health facilities for childbirth. The adjusted odds ratios (AOR) with their corresponding 95% confidence intervals (CI) were computed using the Statistical Package for Social Sciences, version 30.0. RESULTS: Overall, 58.3% (95% CI: 57.0-59.5) of women did not give birth in a health facility. Women were more likely to give birth at home or in the village if they had no formal education (AOR: 1.48; 95% CI: 1.11-2.09), lived in rural areas (AOR: 1.31; 95% CI: 1.11-1.75), were from the Southern (AOR: 1.05; 95% CI: 1.01-1.54), or Momase (AOR: 1.06; 95% CI: 1.02-1.83) regions, made their own healthcare decisions (AOR: 1.21; 95% CI: 1.10-4.14), had these decisions made by their husbands (AOR: 1.69; 95% CI: 1.13-2.63), walked to a health facility (AOR: 1.01; 95% CI: 1.00-1.67), or traveled more than 24 hours to access care (AOR: 1.02; 95% CI: 1.39-2.70), and had no antenatal care visits during pregnancy (AOR: 1.08; 95% CI: 1.04-1.51). CONCLUSIONS: Over half of the women in this study did not utilize health facilities for childbirth. Demographic and health service-related factors influenced the non-utilization of facility-based childbirth, highlighting the need to scale up maternal health services. Increasing uptake of facility-based childbirth requires coordinated system-level efforts and incentive-based interventions that promote antenatal care and skilled birth attendance, especially for rural women. Male-inclusive strategies in maternal health decision-making are critical for improving women's access to and utilization of facility-based childbirth services.