A discrete choice experiment to determine facility-based delivery services desired by women and men in rural Ethiopia

Beam, Nancy; Dadi, Gezahegn Bekele; Rankin, Sally H.; Weiss, Sandra J.; Cooper, Bruce A.; Thompson, Lisa

doi:10.1136/bmjopen-2017-016853

Cited by 11 publications

(22 citation statements)

References 61 publications

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“…The study nding shown that, awareness on skilled delivery and number of birth were signi cantly associated with skilled delivery care utilization among the marginalized mothers in the study area. The awareness of mothers about delivery care is comparable with ndings of the previous study, but conversely, number of birth was not similar with previous ndings (12,22). This discrepancy of the ndings might be due to difference in access to health service in different communities.…”

Section: Resultssupporting

confidence: 47%

Skilled Delivery Care Service Uptake Among Socially Marginalized Women in Kambata-Tembaro Zone, Southern Ethiopia

Alemu

Assefa

Ahmed

et al. 2020

Preprint

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Background: Globally, 358,000 women die during pregnancy and childbirth every year. Poor skilled delivery health care uptake remains a significant problem in developing countries. In Ethiopia, skilled delivery care service uptake was law. Marginalized women are vulnerable for poor delivery care uptake and addressing woman’s’ social marginalization could play an important role in increasing uptake of skilled delivery care service among minorities in the study area. Thu, the study was aimed to access the utilization of delivery care uptake and associated factors among women from socially marginalized minorities in the Kambeta-Temabaro, Zone Southern Ethiopia. Methods: Community based cross-sectional study was conducted from April 01 to March 30, 2019. Multistage sampling procedure was employed to enroll 521 study participants. An interviewer administered questionnaire was used to collect the data. Data was entered using EPI- INFO and exported to Statistical Package for Social Science (SPSS)-21 for analysis. The degree of association was assessed using odds ratio with 95% confidence interval and the variable with p-value <0.05 were declared as statistically significant. The model fitness was checked using Pearson’s Chi-square with the value of 3.45 and significance 0.026 Result: The magnitude of skilled delivery care service uptake among socially marginalized minorities was 19% in the study area. Maternal education, occupation, and awareness on delivery care, pregnancy plan, and number of birth, mothers’ life-style, and social discrimination were significantly associated with the delivery care service uptake among women from socially marginalized minorities. Conclusion: The prevalence of the delivery service utilization among marginalized mothers was found to be low [19%]. Mothers’ education, occupation, life-style, awareness, number of birth and social discrimination was significantly associated with delivery service uptake from health facilities in Kambata-Tembaro zone, Southern Ethiopia. Thus, intervention on social discrimination in the community to breakthrough core barriers; improving women awareness though health education and promotion; and accessing education and employment for women are highly recommended.

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Section: Resultssupporting

confidence: 47%

Skilled Delivery Care Service Uptake Among Socially Marginalized Women in Kambata-Tembaro Zone, Southern Ethiopia

Alemu

Assefa

Ahmed

et al. 2020

Preprint

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“…Barriers to accessing skilled delivery services in rural Sub-Saharan Africa are well documented and commonly cited factors include: fear of mistreatment or abuse in facilities [14,15], long distance and difficulty in access [9], poverty and education [9], lack of decision-making power and support [8,16], other cultural issues such as birth position and preference for traditional birth attendants [13,17], lack of knowledge of risk and promotion of health seeking behavior [18].…”

Section: Increase Coverage Of Health Facility Delivery From 50mentioning

confidence: 99%

Factors influencing adoption of facility-assisted delivery - a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania

Mosley

Saruni

Lenga³

2020

BMC Pregnancy Childbirth

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Background Tanzania’s One Plan II health sector program aims to increase facility deliveries from 50 to 80% from 2015 to 2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who robustly prefer home births to facility births even after completing 4+ ANC visits. Ebiotishu Oondomonok Ongera (EbOO) is a program in Nainokanoka ward to promote facility births through a care-group model using trained traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for delivery. A qualitative study was conducted to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver. Methods In-depth interviews, focus group discussions and key-informant interviews were conducted with 24 pregnant and/or parous women, 24 TBAs, 3 nurse midwives at 3 health facilities, and 24 married men, living in Nainokanoka ward. Interviews and discussions were transcribed, translated, and analyzed thematically using a grounded theory approach. Results Most women interviewed expressed preference for a home birth with a TBA and even those who expressed agency and preference for a facility birth usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery. TBAs report support for facility deliveries but in practice use them as a last resort, and a significant trust gap was documented based on a bad experience at a facility where women in labor were turned away. Conclusions EbOO project data and study results show a slow but steady change in norms around delivery preference in Nainokanoka ward. Gaps between expressed intention and practice, especially around ‘unexpected labor’ present opportunities to accelerate this process by promoting birth plans and perhaps constructing a maternity waiting house in the ward. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services, and increased sensitivity to women’s cultural preferences, could also close the gap between the number of women who are currently using facilities for ANC and those returning for delivery.

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“…The majority of existing literature on DCEs in relation to maternity care in LMICs has focussed on preferences for intrapartum care, generally with the aim of understanding how to encourage more women to birth in healthcare facilities [7][8][9][10][11][12]. Only one prior DCE regarding antenatal care was identified.…”

Section: Introductionmentioning

confidence: 99%

Women’s preferences for antenatal care in Tanzania: a discrete choice experiment

Camacho

Smyth

Danna

et al. 2022

BMC Pregnancy Childbirth

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Background The stillbirth rate in Tanzania remains high. Greater engagement with antenatal care may help to reduce stillbirths. We investigated which characteristics of antenatal care clinics are preferred by pregnant women in Tanzania. Methods We conducted an unlabelled discrete choice experiment (DCE) with think-aloud interviews. Participants were pregnant women, regardless of parity/gestation, from the Mwanza and Manyara regions of Tanzania. We asked participants to choose which of two hypothetical antenatal clinics they would rather attend. Clinics were described in terms of transport mode, cleanliness, comfort, visit content, and staff attitude. Each participant made 12 choices during the experiment, and a purposively selected sub-set simultaneously verbalised the rationale for their choices. We analysed DCE responses using a multinomial logit model adjusted for study region, and think-aloud data using the Framework approach. Results We recruited 251 participants split evenly between the 2 geographical regions. Staff attitude was the most important attribute in clinic choice and dominated the think-aloud narratives. Other significant attributes were mode of transport (walking was preferred) and content of clinic visit (preference was stronger with each additional element of care provided). Cleanliness of the clinic was not a significant attribute overall and the think-aloud exercise identified a willingness to trade-off cleanliness and comfort for respectful care. Conclusion Women would prefer to attend a clinic with kind staff which they can access easily. This study suggests that exploration of barriers to providing respectful care, and enabling staff to deliver it, are important areas for future investment. The DCE shows us what average preferences are; antenatal care that is aligned with identified preferences should increase uptake and engagement versus care which does not acknowledge them.

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A discrete choice experiment to determine facility-based delivery services desired by women and men in rural Ethiopia

Cited by 11 publications

References 61 publications

Skilled Delivery Care Service Uptake Among Socially Marginalized Women in Kambata-Tembaro Zone, Southern Ethiopia

Skilled Delivery Care Service Uptake Among Socially Marginalized Women in Kambata-Tembaro Zone, Southern Ethiopia

Factors influencing adoption of facility-assisted delivery - a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania

Women’s preferences for antenatal care in Tanzania: a discrete choice experiment

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