‘Born before arrival’: user and provider perspectives on health facility childbirths in Kapiri Mposhi district, Zambia

Abstract

BackgroundMaternal mortality remains high in sub-Saharan Africa. Health facility intra-partum strategies with skilled birth attendance have been shown to be most effective to address maternal mortality. In Zambia, the health policy for pregnant women is to have facility childbirth, but less than half of the women utilize the facilities for delivery. ‘Born before arrival’ (BBA) describes childbirth that occurs outside health facility. With the aim to increase our understanding of trust in facility birth care we explored how users and providers perceived the low utilization of health facilities during childbirth.MethodsA qualitative study was conducted in Kapiri Mposhi, Zambia. Focus group discussions with antenatal clinic and outpatient department attendees were conducted in 2008 as part of the Response to Accountable priority setting and Trust in health systems project, (REACT). In-depth interviews conducted with women who delivered at home, their husbands, community leaders, traditional birth attendants, and midwives were added in 2011. Information was collected on perceptions and experiences of home and health facility childbirth, and reasons for not utilizing a facility at delivery. Data were analysed by inductive content analysis.ResultsPerspectives of users and providers were grouped under themes that included experiences related to promotion of facility childbirth, responsiveness of health care providers, and giving birth at home. Trust and quality of care were important when individuals seek facility childbirth. Safety, privacy and confidentiality encouraged facility childbirth. Poor attitudes of health providers, long distances and lack of transport to facilities, costs to buy delivery kits, and cultural ideals that local herbs speed up labour and women should exhibit endurance at childbirth discouraged facility childbirth.ConclusionTrust and perceived quality of care were important and influenced health care seeking at childbirth. Interventions that include both the demand and supply sides of services with prioritizing needs of the community could substantially improve trust and utilization of facilities at childbirth, and accelerate efforts to achieve MDG5.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-323) contains supplementary material, which is available to authorized users.

Measuring the impact of non‐monetary incentives on facility delivery in rural Zambia: a clustered randomised controlled trial

“…Non-randomised studies have found large impacts of non-monetary incentives on utilisation of health services including HIV counselling and testing [18], prenatal care [8] and immunisation services [7]. However, the factors that influence whether a woman delivers at a facility are often a more complex combination of individual and environmental-level factors than those that may influence whether someone attends shorter, less time-critical health services [20][21][22]. Several studies have noted that the primary barriers in rural areas to delivering at a health facility in sub-Saharan Africa are long distances to health facilities and a lack of transport [22][23][24][25].…”

Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya

“…Social and cultural factors including previous successful home deliveries, belief that local herbs speed up labour, belief that women should exhibit endurance during child birth, lack of participation in decision making, ready availability of traditional birth attendants(TBA), and presence of male midwifes in health facilities have also been identified as deterrents to hospital deliveries[8,12,28,30]. …”

Impact of Pregnancy-Related Deaths on Female Life Expectancy in Zambia: Application of Life Table Techniques to Census Data

“…One in every three women aged 15–19 in rural areas is either already a mother or pregnant compared to one in every five in urban areas [42]. Further, women in rural areas are far less likely to seek professional assistance for childbirth due to distance, fewer skilled health care workers, and fewer and poorly equipped health facilities compared to women in urban areas [43–47]. Giving birth without skilled attendance is associated with greater risk of mortality [48].…”