The absence of skilled care during home deliveries represents a critical public health concern, as it has a significant impact on maternal mortality rates. The World Health Organization (WHO) reports that approximately 287,000 women worldwide died in 2020 due to maternal causes, equating to more than 800 maternal deaths each day. The study aimed at analyzing trends, spatial distribution and determinants of maternal home deliveries in Zambia between 1992 and 2018. The study used data from six rounds of the Zambia Demographic and Health Survey (ZDHS). A weighted sample of 6,230 women in 1992, 7,136 in 1996, 6,594 in 2001/02, 13,211 in 2013/14 and 9,731 in 2018 who delivered at home or health facility five years preceding the survey. Univariate and bivariate analyses were employed to examine trends in maternal home deliveries based on selected individual and community-level factors from 1992 to 2018.Spatial analysis was used to highlight regional disparities in maternal home births. The multilevel logistic regression model was used to analyze the potential predictors of maternal home deliveries using STATA version 15. The prevalence of maternal home deliveries in Zambia decreased from 49% in 1992 to 15% in 2018. Spatial analysis showed regional variations, with the Northern province consistently having the highest prevalence of home births. Multilevel logistic regression highlighted the influence of individual and selected community factors of home deliveries. The results show that women with primary, secondary, and higher education had significantly reduced odds of delivering at home compared to women with no education from 1992 to 2018. In 2018, women with primary, secondary, and higher education had a 35%, 62%, and 96% reduction in the odds of delivering at home compared to women with no education [aOR = 0.65, 95% CI: 0.49–0.88; aOR = 0.38, 95% CI: 0.26–0.56; aOR = 0.04, 95% CI: 0.01–0.74]. Women in middle and rich quintile, attending at least one antenatal care reduced the likelihood of delivering at home. In terms of selected community factors, women from rural residence had increased odds of home delivery across all the survey years. Despite a decline in maternal home deliveries, rural women continue to choose this option due to factors such as lack of education, higher parity, limited media exposure, and inadequate antenatal care. Regional and community variations also influence these choices. These findings can guide health policy by targeting interventions in rural areas, improving education, and enhancing access to antenatal care to reduce home deliveries and improve maternal health outcomes.

Grand multiparity, defined as having five or more births, is a significant public health problem, especially in low resource settings where fertility rates are generally higher than in high-resource settings due to socio-economic factors such as poverty and low levels of women’s education, as well as disparities in access to modern contraceptives and advanced medical care. The study aimed to investigate the factors associated with grand multiparity in Zambia. The study analysed data from the 2018 Zambia Demographic and Health Survey (ZDHS) using a weighted sample of 13,683 women aged 15–49 years. Univariate analysis was used to present percent distributions of the selected background characteristics of women. Bivariate analysis was used to examine the association between selected background characteristics and grand multiparity. Multivariable logistic regression was then performed to identify factors of grand multiparity among women aged 15–49 years in Zambia. The prevalence of grand multiparity among women in Zambia was estimated at 24%. Women aged 25–29 years, 30–34 years, and 35 years or older had significantly higher odds of grand multiparity compared to women aged 15–24 years, with the highest odds observed in women aged 35 years or older (aOR=56.31, 95% CI: 11.626–272.780). Women with a first birth at age 25 years or older were 86% less likely to experience grand multiparity (aOR=0.14, 95% CI: 0.084–0.238). Higher education and wealth were protective factors, with women who attained secondary education (aOR=0.28, 95% CI: 0.182–0.418) and higher education (aOR=0.09, 95% CI: 0.046–0.174) having reduced odds of grand multiparity. Women from richer households were also less likely to experience grand multiparity (aOR=0.48, 95% CI: 0.337–0.701). Rural residence (aOR=1.46, 95% CI: 1.111–1.911) and contraceptive use (aOR=1.29, 95% CI: 1.074–1.545) were associated with increased odds of grand multiparity. Women with shorter birth intervals (less than 24 months) were almost three times more likely to be grand multiparous (aOR=2.74, 95% CI: 1.741–4.326). The findings underscore the complex interplay of socio-demographic factors in shaping reproductive patterns in Zambia. Strategies to reduce grand multiparity should consider promoting delayed marriage, increasing access to education and addressing rural-urban disparities in healthcare access and family planning services.