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

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 < 0.001), parity > 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