Exploring women and traditional birth attendants’ perceptions and experiences of stillbirths in district Thatta, Sindh, Pakistan: a qualitative study

Abstract

Background: Pakistan reports the highest stillbirth rate in the world at 43 per thousand births with more than three-quarters occurring in rural areas. The Global Network for Women's and Children's Health maintains a Maternal and Newborn Health Registry (MNHR) in 14 study clusters of district Thatta, Sindh Pakistan. For the last 10 years, the MNHR has recorded a high stillbirths rate with a slow decline. This exploratory study was designed to understand the perspectives of women and traditional birth attendants regarding the high occurrence of stillbirth in Thatta district. Methods: We used an exploratory qualitative study design by conducting in-depth interviews (IDIs) and focus group discussions (FGDs) using semi-structured interview guide with rural women (FGDs = 4; n = 29) and traditional birth attendants (FGDs = 4; n = 14) who were permanent residents of Thatta. In addition, in-depth interviews were conducted with women who had experienced a stillbirth (IDIs = 4). This study presents perceptions and experiences of women and TBAs regarding high rate of stillbirth in Thatta district, Karachi. Results: Women showed reluctance to receive skilled/ standard care when in need due to apprehensions towards operative delivery, poor attitude of skilled health care providers, and poor quality of care as service delivery factors. High cost of care, far distance to facility, lack of transport and need of an escort from the family or village to visit a health facility were additional important factors for not seeking care resulting in stillbirth. The easy availability of unskilled provider in the form of traditional birth attendant is then preferred over a skilled health care provider. TBAs shared their husband or family members restrict them to visit or consult a doctor during pregnancy. According to TBAs after delivering a macerated fetus, women are given herbs to remove infection from woman's body and uterus. Further women are advised to conceive soon so that they get rid of infections. Conclusion: Women of this rural community carry lots of apprehension against skilled medical care and as a result follow traditional practices. Conscious efforts are required to increase the awareness of women to develop positive health seeking behavior during pregnancy, delivery and the post-partum period. Alongside, provision of respectful maternity care needs to be emphasized especially at public health facilities.

Influence of Social and Cultural Practices on Maternal Mortality: A Qualitative Study from South Punjab, Pakistan

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“…Finally, this section sought to assess birth delivery assisted by traditional birth attendants from 1988 to 2014. According to [39], unskilled birth attendants are also called traditional birth attendants which is a community-based provider of care during pregnancy and childbirth. In general, there has been a decline in birth assisted by traditional birth attendants in Ghana.…”

Barriers to accessing maternal and newborn care: a qualitative study in district Thatta, Pakistan

“…This nding is consistent with data from Pakistan which indicates that 41% of deliveries in rural areas take place at home (6). Similarly, Mcnojia et al also cite that husbands restrict wives from visiting doctors during pregnancy in Thatta, Sindh (33). A reason for this phenomenon may stem from the fact that conventional gender norms in Pakistan dictate that men are responsible to nancially provide for the family (34) .…”

“…This was because in all cases patients had to arrange private transportation for routine checkups. In addition, essential equipment for pregnancy check-ups such as ultrasound machines are only present in district level hospitals which can be located anywhere between 20 to 70 km from rural villages (33). The average cost to arrange a private vehicle across this distance in Thatta is 2000 rupees (13US$) for a round trip.…”