Skilled Birth Attendance and Health-Related Quality of Life among Young Mothers in Eastern Uganda: Evidence from a Cross-Sectional Study

Abstract

Skilled birth attendance (SBA) is a cornerstone of safe motherhood, reducing maternal and newborn morbidity and mortality through the timely prevention and management of childbirth complications. However, although its survival benefits are well established, limited evidence exists on its association with health-related quality of life (HRQoL), particularly among young mothers in low-resource settings. This study examined the association between skilled birth attendance and HRQoL among young mothers aged 10–24 years in Eastern Uganda. A community-based cross-sectional analytical study was conducted among 967 young mothers who had delivered within the previous six months in Kamuli, Pallisa, and Ngora districts. Data were collected using structured interviewer-administered questionnaires. SBA was measured using questions adapted from the USAID Demographic and Health Survey (DHS) Woman's Questionnaire and HRQoL was assessed using the WHOQOL-BREF global quality-of-life measure. Skilled birth attendance was defined as childbirth assisted by an accredited doctor, nurse, or midwife in accordance with World Health Organization recommendations. Descriptive statistics summarized participant characteristics, while chi-square tests, one-way ANOVA, and ordered logistic regression examined the association between SBA and HRQoL. Young mothers who delivered with skilled health professionals had significantly higher odds of reporting better HRQoL than those who did not (OR = 1.761, 95% CI: 1.345–2.306; z = 4.12, p< 0.001). Although the regression model was statistically significant (LR χ² = 17.01, p< 0.001), the pseudo-R² of 0.006 indicates that HRQoL was also influenced by other individual, social, and health-system factors. These findings demonstrated that skilled birth attendance was positively associated with better health-related quality of life among young mothers, suggesting that its benefits extend beyond preventing maternal and newborn complications to supporting broader maternal well-being. Strengthening equitable access to skilled, respectful, and adolescent-responsive delivery care, alongside interventions that address broader social and health-system barriers, may improve maternal well-being and quality of life among young mothers in Eastern Uganda and similar settings among this vulnerable population.