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Why do women not use skilled birth attendance service? An explorative qualitative study in north West Ethiopia.

ABSTRACT: BACKGROUND:Having a birth attendant with midwifery skills during childbirth is an effective intervention to reduce maternal and early neonatal morbidity and mortality. Nevertheless, many women in Ethiopia still deliver a baby at home. The current study aimed at exploring and describing reasons why women do not use skilled delivery care in North West Ethiopia. METHODS:This descriptive explorative qualitative research was done in two districts of West Gojjam Zone in North West Ethiopia. Fourteen focus group discussions (FGDs) were conducted with pregnant women and mothers who delivered within one year. An inductive thematic analysis approach was employed to analyse the qualitative data. The data analysis adhered to reading, coding, displaying, reducing, and interpreting data analysis steps. RESULTS:Two major themes client-related factors and health system-related factors emerged. Factors that emerged within the major theme of client-related were socio-cultural factors, fear of health facility childbirth, the nature of labour, lack of antenatal care (ANC) during pregnancy, lack of health facility childbirth experience, low knowledge and poor early care-seeking behaviour. Under the major theme of health system-related factors, the sub-themes that emerged were low quality of service, lack of respectful care, and inaccessibility of health facility. CONCLUSIONS:This study identified a myriad of supply-side and client-related factors as reasons given by pregnant women, for not giving birth in health institution. These factors should be redressed by considering the specific supply-side and community perspectives. The results of this study provide evidence that could help policymakers to develop strategies to address barriers identified, and improve utilisation of skilled delivery service.

SUBMITTER: Shiferaw BB

PROVIDER: S-EPMC7574439 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Why do women not use skilled birth attendance service? An explorative qualitative study in north West Ethiopia.

Shiferaw Biruhtesfa Bekele BB Modiba Lebitsi Maud LM

BMC pregnancy and childbirth 20201019 1

<h4>Background</h4>Having a birth attendant with midwifery skills during childbirth is an effective intervention to reduce maternal and early neonatal morbidity and mortality. Nevertheless, many women in Ethiopia still deliver a baby at home. The current study aimed at exploring and describing reasons why women do not use skilled delivery care in North West Ethiopia.<h4>Methods</h4>This descriptive explorative qualitative research was done in two districts of West Gojjam Zone in North West Ethio ...[more]

PMID: 33076867

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Project description:IntroductionDespite remarkable progress in maternal and neonatal health over past two decades, maternal and neonatal mortality in Bangladesh remain high, which is partially attributable to low use of skilled maternal and newborn health (MNH) services. Birth preparedness and complications readiness (BCPR) is recommended by the World Health Organization and by the Government of Bangladesh as a key intervention to increasing appropriate MNH services. This study aims to explore the status of BPCR in a hard-to-reach area of rural Bangladesh and to demonstrate how BPCR practices is associated with birth in the presence of a skilled birth attendant.MethodsData was collected using multistage cluster sampling-based household survey in two sub-districts of Netrokona, Bangladesh in 2014. Interviews were conducted among women with a recent birth history in 12-months and their husbands. Univariate, bivariate, and multivariable analysis using Stata 14.0 were performed from 317 couples.ResultsMean age of respondents was 26.1 (SD ± 5.3) years. There was a significant difference in BPCR practice between women and couples for identification of the place of birth (84% vs. 75%), identification of a birth attendant (89% vs.72%), arranging transport for birth or emergencies (20% vs. 13%), and identification of a blood donor (15% vs. 8%). In multivariable analysis, odds of giving birth in presence of a skilled birth attendant consistently increased with higher completeness of preparedness (OR 3.3 for 3-5 BPCR components, OR 5.5 for 4-5 BPCR components, OR 10.4 for all 5 BPCR components). For different levels of completeness of BPCR practice, the adjusted odds ratios were higher for couple preparedness comparatively.ConclusionsBPCR is associated with birth in the presence of a skilled attendant and this effect is magnified when planning is carried out by the couple. Interventions aiming to increase BPCR practices should not focus on women only, as involving the couple is most likely lead to positive care-seeking practices.

Project description:BackgroundImproving institutional delivery service is the most crucial strategies to reduce maternal and neonatal mortalities. In developing countries, only 50% of pregnant women deliver in health facilities and in Ethiopia only 48% of pregnant women deliver in health facilities. Maternal mortality remains the highest in Ethiopia. This study assessed intention to use institutional delivery service and its predictors among pregnant women using theory of planned behavior.MethodsCommunity-based cross-sectional study was conducted among 645 Yilmana Densa District Pregnant women using multi-stage followed by cluster sampling technique. Data were entered into Epi Data version 4.6.0.2 and analyzed with STATA version 14. Binary logistic regression analysis was done to identify independent predictors of intention at 95% confidence level and P < 0.05 was used to determine statistically significant predictors.ResultsIntention of pregnant women to use institutional delivery service was 74.3% (CI; 70.71%, 77.6%). In the multivariable logistic regression; those who had 1-3 and 4 &above antenatal care 2.85(1.41, 5.75) and 3.14(1.16, 8.45) respectively, those who had past experience of institutional delivery (AOR = 3.39, 95%CI: 1.72, 6.71), parity of 1-3 and 4 & above % (AOR = 0.37, 0.19, 0.71) and (AOR = 0.25, 95%CI: 0.12, 0.55) respectively, rural residence (AOR = 0.51, 95%CI: 0.27, 0.96), favorable attitude (AOR = 2.93, 95%CI: 1.56, 5.50), favorable perceived behavioral control (AOR = 2.60, 95%CI: 1.44, 4.69) were factors significantly associated with intention to use institutional delivery service.Conclusion and recommendationMajority of the pregnant women were intended to deliver in the institution. Good Knowledge on institutional delivery, antenatal care visit, past experience of institutional delivery, rural residence, parity, attitude and perceived behavioral control were identified factors significantly associated with intention to use institutional delivery service. So, strengthening awareness creation and behavioral change communication programs are required at all levels of health system to raise intention of residents towards institutional delivery.

Project description:BackgroundUganda, a low resource country, implemented the skilled attendance at birth strategy, to meet a key target of the 5th Millenium Development Goal (MDG), 75% reduction in maternal mortality ratio. Maternal mortality rates remained high, despite the improvement in facility delivery rates. In this paper, we analyse the strategies implemented and bottlenecks experienced as Uganda's skilled birth attendance policy was rolled out. These experiences provide important lessons for decision makers as they implement policies to further improve maternity care.MethodsThis is a case study of the implementation process, involving a document review and in-depth interviews among key informants selected from the Ministry of Health, Professional Organisations, Ugandan Parliament, the Health Service Commission, the private not-for-profit sector, non-government organisations, and District Health Officers. The Walt and Gilson health policy triangle guided data collection and analysis.ResultsThe skilled birth attendance policy was an important priority on Uganda's maternal health agenda and received strong political commitment, and support from development partners and national stakeholders. Considerable effort was devoted to implementation of this policy through strategies to increase the availability of skilled health workers for instance through expanded midwifery training, and creation of the comprehensive nurse midwife cadre. In addition, access to emergency obstetric care improved to some extent as the physical infrastructure expanded, and distribution of medicines and supplies improved. However, health worker recruitment was slow in part due to the restrictive staff norms that were remnants of previous policies. Despite considerable resources allocated to creating the comprehensive nurse midwife cadre, this resulted in nurses that lacked midwifery skills, while the training of specialised midwives reduced. The rate of expansion of the physical infrastructure outpaced the available human resources, equipment, blood infrastructure, and several health facilities were not fully functional.ConclusionUganda's skilled birth attendance policy aimed to increase access to obstetric care, but recruitment of human resources, and infrastructural capacity to provide good quality care remain a challenge. This study highlights the complex issues and unexpected consequences of policy implementation. Further evaluation of this policy is needed as decision-makers develop strategies to improve access to skilled care at birth.

Project description:Introduction Despite the efforts and strategies being applied by the government and the partner organizations to increase maternal health service utilization, maternal health service utilization is low in the general population and very low in rural communities of the West Shoa Zone specifically. Objective This study intended to identify and describe barriers contributing to low maternal health service utilization in selected rural districts of the West Shoa Zone of Oromia regional state, Ethiopia, by 2021. Methods The study was conducted from February 01 to April 30/2021 in three districts of the West Shoa Zone. The districts were selected purposively based on the report of their last year’s (2020) performance on maternal health service utilization obtained from the Zonal health office, where the ANC follow-up and Institutional delivery were the lowest among the Districts in the Zone. A community-based qualitative phenomenological approach was used to explore the demand-supply side barriers affecting the utilization of maternal health services. Six Focus Group discussions, 9 In-depth Interviews, and 12 Key Informants Interviews were conducted with women who gave birth at home in the last 12 months and with health care providers at different health offices and health institutions. Data were tape-recorded, transcribed verbatim, translated, and analyzed thematically using MAXQDA software. Results Our findings revealed that though women strongly agree on the importance and advantage of maternal health services utilization, both demand and supply side barriers such as low awareness on when to use the services, not knowing ANC schedule, misinformation about ANC and institutional delivery, not knowing their estimated date of delivery and precipitated labor, shortage of manpower at health institutions, far distance health facilities, and unavailability or un-accessibility of ambulance services during an emergency time, lack of transportation to health facilities were hindering them not to use the services. Conclusion In general, rural women are facing many challenges yet to accessing and utilizing maternal health services. To achieve the SDG targets, addressing barriers prohibiting a woman from using MCH should be critically addressed.

Project description:BackgroundDespite a significant increase in the skilled birth assisted (SBA) deliveries in India, there are huge gaps in availing maternity care services across social gradients - particularly across states and regions. Therefore, this study applies the spatial-regression model to examine the spatial distribution of SBA across districts of India. Furthermore, the study tries to understand the spatially associated population characteristics that influence the low coverage of SBA across districts of India and its regions.MethodsThe study used national representative cross-sectional survey data obtained from the fourth round of National Family Health Survey, conducted in 2015-16. The effective sample size was 259,469 for the analysis. Moran's I statistics and bivariate Local Indicator for Spatial Association maps were used to understand spatial dependence and clustering of deliveries conducted by SBA coverage in districts of India. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of deliveries conducted by SBA.ResultsMoran's I value for SBA among women was 0.54, which represents a high spatial auto-correlation of deliveries conducted by SBA over 640 districts of India. There were 145 hotspots for deliveries conducted by SBA among women in India, which includes almost the entire southern part of India. The spatial error model revealed that with a 10% increase in exposure to mass media in a particular district, the deliveries conducted by SBA increased significantly by 2.5%. Interestingly, also with the 10% increase in the four or more antenatal care (ANC) in a particular district, the deliveries conducted by SBA increased significantly by 2.5%. Again, if there was a 10% increase of women with first birth order in a particular district, then the deliveries conducted by SBA significantly increased by 6.1%. If the district experienced an increase of 10% household as female-headed, then the deliveries conducted by SBA significantly increased by 1.4%.ConclusionThe present study highlights the important role of ANC visits, mass media exposure, education, female household headship that augment the use of an SBA for delivery. Attention should be given in promoting regular ANC visits and strengthening women's education.

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Why do women not use skilled birth attendance service? An explorative qualitative study in north West Ethiopia.

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Why do women not use skilled birth attendance service? An explorative qualitative study in north West Ethiopia.

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