Why do women prefer home births in Ethiopia?

BMC Pregnancy and Childbirth

Michael Tekie²  Yilma Melkamu³  Merijn Godefrooij⁴  Mark Spigt⁵  Solomon Shiferaw¹ 

[1]School of Public Health, Addis Ababa University, PO Box 9086, code 1000, Addis Ababa, Ethiopia

[2]UNFPA-Ethiopia Country Office, Addis Ababa, Ethiopia

[3]Technical Advisor-GCACP, International Planned Parenthood Federation, Nairobi, Kenya

[4]Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands

[5]Department of General Practice, Tromso University, Tromso, Norway

关键词: Ethiopia;    Place of delivery;    Preference;    Traditional birth attendants;    Home births;   

Others  :  1151310
DOI  :  10.1186/1471-2393-13-5

 received in 2012-06-02, accepted in 2013-01-09,  发布年份 2013

【 摘 要 】

Background

Skilled attendants during labor, delivery, and in the early postpartum period, can prevent up to 75% or more of maternal death. However, in many developing countries, very few mothers make at least one antenatal visit and even less receive delivery care from skilled professionals. The present study reports findings from a region where key challenges related to transportation and availability of obstetric services were addressed by an ongoing project, giving a unique opportunity to understand why women might continue to prefer home delivery even when facility based delivery is available at minimal cost.

Methods

The study took place in Ethiopia using a mixed study design employing a cross sectional household survey among 15–49 year old women combined with in-depth interviews and focus group discussions.

Results

Seventy one percent of mothers received antenatal care from a health professional (doctor, health officer, nurse, or midwife) for their most recent birth in the one year preceding the survey. Overall only 16% of deliveries were assisted by health professionals, while a significant majority (78%) was attended by traditional birth attendants. The most important reasons for not seeking institutional delivery were the belief that it is not necessary (42%) and not customary (36%), followed by high cost (22%) and distance or lack of transportation (8%). The group discussions and interviews identified several reasons for the preference of traditional birth attendants over health facilities. Traditional birth attendants were seen as culturally acceptable and competent health workers. Women reported poor quality of care and previous negative experiences with health facilities. In addition, women’s low awareness on the advantages of skilled attendance at delivery, little role in making decisions (even when they want), and economic constraints during referral contribute to the low level of service utilization.

Conclusions

The study indicated the crucial role of proper health care provider-client communication and providing a more client centered and culturally sensitive care if utilization of existing health facilities is to be maximized. Implications of findings for maternal health programs and further research are discussed.

【 授权许可】

   
2013 Shiferaw et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Hogan MC, et al.: Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards millennium development goal 5. Lancet 2010, 375(9726):1609-1623.
• [2]Demographic E, Survey H: Central Statistical Agency. Addis Ababa Ethiopia: MEASURE DHS, ICF International Calverton, Maryland, USA; 2011. 2012
• [3]Ethiopian Ministry of Health: Emergency Obstetric and Neonatal Care survey report. Ethiopia: Ministry of Health; 2009.
• [4]Starrs A: The safe motherhood action agenda: Priorities for the next decade. Report on the safe motherhood technical consultation 18–23 October 1997, Colomba, Sri Lanka, family care international/the inter-agency group for safe motherhood, New York. New York: Family Care International/The Inter-Agency Group for safe motherhood; 1997.
• [5]AbouZahr C: Global burden of maternal death and disability. Br Med Bull 2003, 67:1-11.
• [6]Khan KS, W.D , Say L, Gulmezoglu AM, Van Look P: WHO systematic review of causes of maternal deaths. Lancet 2006, 367:1066-1074.
• [7]Harvey SA, Ayabacab P, Bucaguc M, Djibrinad S, Edsona WN, Gbangbadee S, et al.: Skilled birth attendant competence: An initial assessment in four countries, and implications for the safe motherhood movement. Int J Gynecol Obstet 2004, 87:203-210.
• [8]Koblinsky MA, C.O. , Heichelheim J: Organizing delivery care: what works for safe motherhood? Bull World Health Organ 1999, 77:399-404.
• [9]E, B.S.a.G: The role of traditional birth attendants in the reduction of maternal mortality. Stud Health Serv Organization Policy 2001, (17):85-89.
• [10]Dhakal S, van Teijlingen E, Raja EA, Dhakal KB: Skilled care at birth among rural women in Nepal: practice and challenges. J Health Popul Nutr 2011, 29(4):371-378.
• [11]Gage AJ: Barriers to the utilization of maternal health care in rural Mali. Soc Sci Med 2007, 65:1666-1682.
• [12]Gabrysch S, C.S , Cox J, Campbell OMR: The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system. PLoS Med 2011, 8(1):1-12.
• [13]D., H : Household characteristics affecting where mothers deliver in rural Kenya. Health Econ 1996, 5(4):333-340.
• [14]E., M.D.M.G: Maternal health and health sector reform: opportunities and challenges. Stud Health Serv Organisation Policy 2001, 17:371-386.
• [15]Le Coeur S, Pictet G, M'Pelé P, Lallemant M: Direct estimation of maternal mortality in Africa. Lancet 1998, 352:1525-1526.
• [16]S. B: Appropriate obstetric technologies to deal with maternal complications. Stud Health Serv Organisation Policy 2001, 17:175-194.
• [17]P. B: Over-medicalisation of maternal care in developing countries. Stud Health Serv Organisation Policy 2001, 17:195-206.
• [18]Lerberghe , V.D.B.a.W.V: Safe motherhood strategies: a review of the evidence. Stud Health Serv Organisation Policy 2001., 17
• [19]Upgrading Kembati Mentti Gezzime Health Centre for Obstetric Fistula Prevention and Treatment. Ethiopia: UNFPA – Ethiopia Project document; 2006.
• [20]Department of Public Health and Clinical Medicine at Umeå University: OpenCode 3.6 B1 © UMDAC and Epidemiology. 2009.
• [21]Keenan KF, Pitchforth E, E.v.T: The analysis of qualitative research data in family planning and reproductive health care. J Fam Plann Reprod Health Care 2005, 31(1):40-43.
• [22]Carter A: "Factors That Contribute to the Low Uptake of Skilled Care During Delivery in Malindi, Kenya". ISP Collection, Health and Development program, Kenya; 2010. Paper 821
• [23]Magoma M, J.R , Campbell OMR, Cousens S, Filippi V: High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention. BMC Pregnancy Childbirth 2010, 10(13):1-12.
• [24]Lancet editorial board: Home birth-proceed with caution. Editorial. Lancet 2010, 376(9738):303.
• [25]Margaret E, Kruk MP, Mbaruku G, de Pinho H, Galea S: Women’s preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment. Am J Public Health 2009, 99:1666-1672.
• [26]Kruk ME, Paczkowski MM, Tegegn A, Tessema F, Hadley C, Asefa M, Galea S: Women’s preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery. J Epidemiol Community Health 2010, 64:984-988.
• [27]Wendy Christiaens P: Place of birth and satisfaction with childbirth in Belgium and the Netherlands. Midwifery 2009, 25:e11-e19.
• [28]Imogie AO, E.A. , Aluko K: Assessing the role of traditional birth attendants (TBAs) in health care delivery in Edo State, Nigeria. Afr J Reprod Health 2002, 6(2):94-100.
• [29]Ingegerd Hildingsson, U.W.m., and Ingela Ra°destad: Swedish women’s interest in home birth and in-hospital birth center care. Birth 2003, 30(1):11-22.
• [30]Gao Y, L.B. , Sue K, Min H, Belton S: Barriers to increasing hospital birth rates in rural Shanxi Province, China. Reprod Health Matters 2010, 18(36):35-45.
• [31]Bazzano AN, Kirkwood B, Tawiah-Agyemang C, Owusu-Agyei S, Adongo P: Social costs of skilled attendance at birth in rural Ghana. Int J Gynaecol Obstet 2008, 102:91-94.
• [32]Otis KE, B.J.: Barriers to hospital births: why do many Bolivian women give birth at home? Rev Panam Salud Publica 2008, 24(1):46-53.
• [33]Iyaniwura CA, Y.Q.: Utilization of antenatal care and delivery services in Sagamu, south western Nigeria. Afr J Reprod Health 2009, 13(3):111-122.
• [34]SALIHU., Y.M.A.a.H.M: Barriers to the use of antenatal and obstetric care services in rural Kano, Nigeria. J Obstet Gynaecol 2002, 22(6):600-603.
• [35]Gabrysch S, C.L , Bedriñana E, Bautista MA, Malca R, Campbella OMR, Mirandaa JJ: Cultural adaptation of birthing services in rural Ayacucho, Peru. Lessons from the field. Bull World Health Organ 2009, 87:724-729.
• [36]Glei DA, Goldman N, Rodriguez G: Utilization of care during pregnancy in rural Guatemala: does obstetrical need matter? Soc Sci Med 2003, 57:2447-2463.
• [37]Stephenson., L.A.L.a.R.B: Utilization of maternal health care services in the department of Matagalpa, Nicaragua. Rev Panam Salud Publica 2008, 24(2):75-84.
• [38]Weeks, G.W.a.A: Editorial:the role of (traditional) birth attendants with midwifery skills in the reduction of maternal mortality. Trop Med Int Health 1999, 4(8):527-529.
• [39]Sreeramareddy CT, Joshi HS, Sreekumaran BV, Giri S, Chuni N: Home delivery and newborn care practices among urban women in western Nepal: a questionnaire survey. BMC Pregnancy Childbirth 2006, 6:27. BioMed Central Full Text
• [40]Warren C: Care seeking for maternal health: challenges remain for poor women. Ethiop J Health Dev 2010, 24(Special Issue 1):100-104.
• [41]Federal Ministry of Health of Ethiopia: Federal Democratic Republic of Ethiopia Ministry of Health - Maternal and Child Health Package. Addis Ababa, Ethiopia; 2003.
• [42]Okojie, A.O.a.O: Assessment of the role of traditional birth attendants in maternal health care in Oredo Local Government Area, Edo State, Nigeria. J Community Med Primary Health Care 2005, 17(1):55-60.
• [43]Sipe LM, S.a.T.A: Transition to skilled birth attendance: is there a future role for trained traditional birth attendants? J Health Popul Nutr 2006, 24(4):472-478.