Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study

Abstract

BackgroundMaternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers.MethodsWe conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis.ResultsIrregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center.ConclusionThe rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries.

Assessment of Healthcare Utilization among Women Experiencing Childbirth in Suburban Nepal

“…In these areas, women are required to find porters because cars cannot or will not pick them up (Morgan, 2014). In many villages, the major modes of transportation are still by donkey or mule (Khatri, 2017).…”

“…Oftentimes, young girls become pregnant and most drop out of school, perpetuating the poorly educated, young motherhood cycle. Nepalese men are not conventionally involved in childbirth due to the traditional belief in some areas that God becomes angry if they are to touch women in labor or post-labor (Khatri, 2017). Therefore, the mother-in-law becomes the decision-maker of maternal health issues.…”

“…Therefore, it is important to look at the causes for poor antenatal care and reasons for homebirths. In Nepal, there are about 1500 birthing centers available in rural areas, but only 10% of births take place in those facilities (Khatri, 2017). Birthing centers in Nepal are the lowest tier of health facility where women may give birth.…”

“…These birthing centers are standardized across the country, and consist of 2 patient rooms, a treatment room, and a storage area (Morgan, 2014). These centers must consist of one Auxiliary Nurse Midwife (ANM) who is trained as a Skilled Birthing Assistant (SBA), but often are staffed by ANMs who are not additionally trained (Khatri, 2017). The SBA accreditation consists of a 2 month long training program in addition to the 18 month long ANM training.…”

“…The SBA accreditation consists of a 2 month long training program in addition to the 18 month long ANM training. In the SBA program, they specifically learn emergency obstetric and neonatal care, including use of antibiotics, anticonvulsants, and resuscitation (Khatri, 2017). Many newly trained SBAs testified that they could assist deliveries with much more confidence after the focused training program, and performed fewer unnecessary episiotomies (Morgan, 2014).…”