{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T18:57:00Z","timestamp":1774465020341,"version":"3.50.1"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV070172"],"award-info":[{"award-number":["INV070172"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>This study examines women\u2019s childbirth choices between home and institutional settings in the context of the Salud Mesoam\u00e9rica Initiative, a results-based financing program focused on disadvantaged populations. This study characterizes the childbirth experience using the World Health Organization\u2019s Positive Childbirth Experience framework, identifies factors influencing women\u2019s decisions for home versus institutional births, and describes reasons for transitions between these settings, especially for women with multiple pregnancies. A retrospective observational study was carried out using secondary data from household surveys carried out in Guatemala, Chiapas (Mexico), Nicaragua, and Honduras. A two-stage random sample of women (15\u201349 years) who had a live birth within five years preceding the surveys was analyzed. Quality of institutional care and reasons for home birth were categorized into specific domains and data across three follow-up points were analyzed using design-adjusted chi-squared tests (Rao-Scott correction). Finally, for the second follow-up, a sub-analysis explored setting transitions for women with multiple pregnancies. The main results indicate that Guatemala had the highest rate of home births (83.8%), while institutional deliveries were more common in Honduras and Nicaragua. Over time, institutional births increased across the board, notably in Honduras, where they surged from 72.3% to 92.7%. The primary factors influencing birth setting choices were accessibility and cultural preferences, with the latter being particularly significant in Guatemala and Chiapas. The results underscore the critical need for culturally sensitive strategies to boost institutional birth rates. While enhanced accessibility has contributed to more institutional deliveries, deep-seated cultural preferences remain a considerable hurdle. Interventions that respect local beliefs while simultaneously improving the quality of care in institutional settings are essential to ensure safe childbirth for all women.<\/jats:p>","DOI":"10.1371\/journal.pone.0345813","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T17:38:09Z","timestamp":1774460289000},"page":"e0345813","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Examining women\u2019s choice between home and institutional births: Insights from the Salud Mesoam\u00e9rica Initiative (SMI)"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8365-6011","authenticated-orcid":true,"given":"Luc\u00eda","family":"Bartolomeu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7201-2088","authenticated-orcid":true,"given":"Natalia","family":"Basualdo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1664-7023","authenticated-orcid":true,"given":"Federico","family":"Rol\u00f3n","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adolfo","family":"Rubinstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camila","family":"Volij","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt","family":"Simon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brittany","family":"Hagedorn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego","family":"R\u00edos-Zertuche","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6940-9734","authenticated-orcid":true,"given":"Santiago","family":"Esteban","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3789-2332","authenticated-orcid":true,"given":"Adri\u00e1n","family":"Santoro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"pone.0345813.ref001","article-title":"Barriers to access to health services for women and children in Latin America Barreiras de acesso aos servi\u00e7os de sa\u00fade para mulheres e crian\u00e7as na Am\u00e9rica Latina","volume":"46","author":"N Houghton","year":"2022","journal-title":"Rev Panam Salud Publica"},{"key":"pone.0345813.ref002","volume-title":"Sustainable Development in Latin America and the Caribbean: Challenges and Axes of Public Policy","author":"UNSDG","year":"2018"},{"issue":"1","key":"pone.0345813.ref003","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s12939-024-02100-y","article-title":"Persistent inequities in maternal mortality in Latin America and the Caribbean, 1990-2019","volume":"23","author":"R S\u00e1enz","year":"2024","journal-title":"Int J Equity Health"},{"issue":"1","key":"pone.0345813.ref004","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1186\/s12884-024-06549-1","article-title":"Prevalence of different variations of non-consented care during the childbirth process in Mexico by geographical regions: comparing ENDIREH survey data from 2016 to 2021","volume":"24","author":"M Marian","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0345813.ref005","volume-title":"WHO recommendations: Intrapartum care for a positive childbirth experience","author":"World Health Organization","year":"2018"},{"issue":"1","key":"pone.0345813.ref006","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s12963-015-0034-4","article-title":"Salud Mesoam\u00e9rica 2015 Initiative: design, implementation, and baseline findings","volume":"13","author":"AH Mokdad","year":"2015","journal-title":"Popul Health Metr"},{"key":"pone.0345813.ref007"},{"issue":"1","key":"pone.0345813.ref008","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12884-021-04279-2","article-title":"Impact of the Salud Mesoamerica Initiative on delivery care choices in Guatemala, Honduras, and Nicaragua","volume":"22","author":"B Hernandez","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"issue":"5","key":"pone.0345813.ref009","doi-asserted-by":"crossref","DOI":"10.9745\/GHSP-D-24-00057","article-title":"Improving Maternity Care Where Home Births Are Still the Norm: Establishing Local Birthing Centers in Guatemala That Incorporate Traditional Midwives","volume":"12","author":"B Lievense","year":"2024","journal-title":"Glob Health Sci Pract"},{"key":"pone.0345813.ref010","doi-asserted-by":"crossref","first-page":"103507","DOI":"10.1016\/j.midw.2022.103507","article-title":"Trends in facility-based childbirth and barriers to care at a birth center and community hospital in rural Chiapas, Mexico: A mixed-methods study","volume":"116","author":"S Truong","year":"2023","journal-title":"Midwifery"},{"key":"pone.0345813.ref011","doi-asserted-by":"crossref","first-page":"100955","DOI":"10.1016\/j.ssmph.2021.100955","article-title":"Prevalence of home birth among 880,345 women in 67 low- and middle-income countries: A meta-analysis of Demographic and Health Surveys","volume":"16","author":"A Hern\u00e1ndez-V\u00e1squez","year":"2021","journal-title":"SSM Popul Health"},{"issue":"6","key":"pone.0345813.ref012","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1093\/heapol\/czx010","article-title":"Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study","volume":"32","author":"B Hernandez","year":"2017","journal-title":"Health Policy Plan"},{"issue":"4","key":"pone.0345813.ref013","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0154388","article-title":"Institutional Delivery and Satisfaction among Indigenous and Poor Women in Guatemala, Mexico, and Panama","volume":"11","author":"DV Colombara","year":"2016","journal-title":"PLoS One"},{"issue":"9","key":"pone.0345813.ref014","doi-asserted-by":"crossref","first-page":"724","DOI":"10.2471\/BLT.08.057794","article-title":"Cultural adaptation of birthing services in rural Ayacucho, Peru","volume":"87","author":"S Gabrysch","year":"2009","journal-title":"Bull World Health Organ"},{"issue":"1","key":"pone.0345813.ref015","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1186\/s12939-015-0289-1","article-title":"Labor and delivery service use: indigenous women\u2019s preference and the health sector response in the Chiapas Highlands of Mexico","volume":"14","author":"M Ib\u00e1\u00f1ez-Cuevas","year":"2015","journal-title":"Int J Equity Health"},{"key":"pone.0345813.ref016","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2147\/OAJC.S153443","article-title":"Does courtesy bias affect how clients report on objective and subjective measures of family planning service quality? A comparison between facility- and home-based interviews","volume":"9","author":"W Hameed","year":"2018","journal-title":"Open Access J Contracept"},{"key":"pone.0345813.ref017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.26633\/RPSP.2019.36","article-title":"Irrespeto y maltrato durante el parto y el aborto en Am\u00e9rica Latina: revisi\u00f3n sistem\u00e1tica y metaan\u00e1lisis","volume":"43","author":"C Tobas\u00eda-Hege","year":"2019","journal-title":"Revista Panamericana de Salud P\u00fablica"},{"issue":"1","key":"pone.0345813.ref018","article-title":"Disrespectful and abusive treatment during facility delivery in Tanzania: a facility and community survey","volume":"33","author":"ME Kruk","year":"2018","journal-title":"Health Policy Plan"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345813","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T17:38:14Z","timestamp":1774460294000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345813"}},"subtitle":[],"editor":[{"given":"Nicolas","family":"Padilla-Raygoza","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":18,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0345813","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]}}}