Socio-demographic factors influencing childbirth location among marginalized communities in northern Thailand

Objective: Despite many health campaigns, childbirth remains dangerous for women and infants in many developing countries. Childbirths are safest in hospitals and with skilled attendants; however, many childbirths still occur in homes. We analyze the association between socio-demographic characteristics, including ethnicity, schooling, and citizenship, and hospital births, an ongoing contributor to health disparities in the development context. Design: Using hierarchical logistic regression, we measure women's odds of hospital births and differentiate these odds by socio-demographic characteristics—specifically ethnicity, education level and language—with and without potential confounders included. Population: We analyze data from the United Nations Educational, Scientific and Cultural Organization Highland Peoples Survey (2010) of 13,534 ethnic Thai and minority women living in highland villages near the Thai-Burma border, a population never before surveyed for health and socioeconomic information. Principal findings: Women's odds of giving birth in a hospital are significantly lower (p<0.01) by 90% when they do not have citizenship, 39% when they are a minority, 50% when they have not had any schooling (compared to having finished upper secondary school), 30% if Thai is not spoken at home, and 49% if a minority language is spoken at home. Conclusions: Maternal and child health disparities exist in Thailand, likely due to unequal access to and unequal utilization of obstetric care services between women of different ethnicities, legal statuses, education levels, and language abilities. Implications: Cultural competence and language services in hospitals must improve and education access, healthcare coverage, and citizenship eligibility must be expanded to reduce these disparities.