Factors influencing the choice of facility-based delivery in the ethnic minority villages of Lao PDR: a qualitative case study

Tropical Medicine and Health

Chika Sato¹  Chiaki Miyoshi²  Noriko Toyama³  Ernesto R. Gregorio³  Tomomi Takayama³  Jun Kobayashi³  Sengchanh Kounnavong⁴  Khampheng Phongluxa⁴  Futoshi Nishimoto⁵  Tiengkham Pongvongsa⁶  Kenzo Takahashi⁷ 

[1] Asia Health and Education Fund;Bureau of International Health Cooperation, National Center for Global Health and Medicine;Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus;Lao Tropical and Public Health Institute, Ministry of Health;Nagasaki University School of Tropical Medicine and Global Health;Savannakhet Provincial Health Department;Teikyo University Graduate School of Public Health;

关键词: Facility-based delivery;    Decision-making;    Ethnic minority;    Qualitative case study;    Thematic analysis;   

DOI  :  10.1186/s41182-019-0177-2

来源: DOAJ

【 摘 要 】

Abstract Background Facility-based delivery has been promoted to improve maternal and child health care in Lao PDR and a free delivery policy was introduced at designated health care facilities (HCF) in 2013. However, according to birth records of HCFs in the impoverished and remote district, only a few women utilized the HCFs despite good physical accessibility. The aim of this study was to analyze the factors influencing the choice of facility-based delivery in the impoverished and remote district after a free delivery policy was introduced. Methods Qualitative case study was employed. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted from August to October 2015. Five hamlets (or small village) located along the main road where only a few women delivered at HCFs were selected for the study based on birth records. The participants of the FGDs and IDIs were the village heads, village health volunteers, women who delivered at home or at a health facility within the past 2 years, their husbands, and mothers or mothers-in-law. Thematic analysis was used to analyze the data. Results A total of 12 FGDs and 27 IDIs were conducted, and the number of participants was 105. The factors influencing the choice of facility-based delivery were classified into nine categories and 19 subcategories. The categories were labeled, “perception of childbirth,” “traditional health concept: sabaai (a condition of health, ease, and comfort),” “perception of health care facilities and staff,” “previous pregnancy and childbirth experience,” “mode of available transportation,” “financial burden of childbirth at health care facility,” “family and community context,” “institutional context,” and “government policy on delivery.” Conclusion Our study demonstrated that five major factors negatively influenced the choice of facility-based delivery: (1) perception of childbirth, (2) preference for sabaai, (3) financial burden, (4) family decision-making, and (5) institutional context. To promote facility-based delivery in the impoverished and remote district, three strategies are recommended: (1) promoting community-based health education involving women and strengthening community-based mutual support, (2) clarifying items essential for delivery at HCFs, and (3) making HCFs more comfortable in terms of “sabaai.”

【 授权许可】

Unknown