Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 18 4 2024 12 22 261 268 Hery Bemanana Regional Directorate of Public Health Atsinanana, Toamasina, Madagascar AND University of Toamasina, Madagascar AND Sylababa Association Madagascar 2024 09 25 2024 11 27 Objective: This study aims to analyze the association between the likelihood of giving birth in a healthcare facility and various sociodemographic characteristics in Madagascar. Materials and methods: This study utilized data from the 2021 Madagascar Demographic and Health Survey which included a representative sample of women of reproductive age (15-49 years). The sociodemographic variables analyzed included age, birth order, education level, region residence and economic status with the place of delivery being the primary dependent variable. Data analysis was conducted using R software. A chi-square test was applied to assess associations between variables, with a significance threshold set at 5%. Results: The prevalence of institutional childbirth services usage in Madagascar was 37.4% (35.1-39.7). The results showed that women under 20 years had an assistance rate of 36.7% (33.9-39.4), while the rate for primiparas reached 49.9% (48.5-51.3). Prenatal visits, mother’s age, birth order, region, residence, education level, and economic quintile significantly influenced access to care, with p-values < 0.0001. Only 17.5% (15.6-19.4) of women in the lowest quintile received qualified assistance at childbirth. Conclusion: The results highlight the impact of age, birth order, residence, education level, region and socioeconomic status on access to childbirth services, necessitating a multisectoral approach to improve equity. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2928 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/2928/705