Exploring women’s decisions of where to give birth in the Peruvian Amazon; why do women continue to give birth at home? A qualitative study

Abstract

Background Despite improvements in maternal mortality globally, hundreds of women continue to die daily. The World Health Organisation therefore advises all women in low-and-middle income countries to give birth in healthcare facilities. Barriers to seeking intrapartum care have been described in Thaddeus and Maine’s Three Delays Model, however these decisions are complex and often unique to different settings. Loreto, a rural province in Peru has one of the highest homebirth rates in the country at 31.8%. The aim of this study was to explore facilitators and barriers to facility births and explore women’s experiences of intrapartum care in Amazonian Peru. Methods Through purposive sampling, postnatal women were recruited for semi-structured interviews (n = 25). Interviews were transcribed verbatim and thematically analysed. A combination of deductive and inductive coding was used. Analytical triangulation was undertaken, and data saturation was used to determine when no further interviews were necessary. Results Five themes were generated from the data: 1) Financial barriers; 2) Accessing care; 3) Fear of healthcare facilities; 4) Importance of seeking care and 5) Comfort and traditions of home. Generally, participants realised the importance of seeking skilled care however barriers persisted, across all areas of the Three Delays Model. Barriers identified included fear of healthcare facilities and interventions, direct and indirect costs, continuation of daily activities, distance and availability of transport. Women who delivered in healthcare facilities had mixed experiences, many reporting good attention, however a selection experienced poor treatment including abusive behaviour. Conclusion Despite free care, women continue to face barriers seeking obstetric care in Amazonian Peru, including fear of hospitals, cost and availability of transport. However, women accessing care do not always receive positive care experiences highlighting implications for changes in accessibility and provision of care. Minimising these barriers is critical to improve maternal and neonatal outcomes in rural Peru.

Pre-pregnancy body mass index and caesarean section in Andean women in Peru: a prospective cohort study

“…Additionally, all participants had the SIS insurance, which only covered medically needed C-sections, and only 10% of C-sections were performed in a clinic. Women still give birth at home aided by traditional community midwives and this can be preferred due to unfamiliarity with hospital care or limited access to care [ 44 ]. Thus, we believe that C-sections in our setting were mainly the result of pregnancy complications and not influenced by women’s preference.…”

“…Still, the health care system faces challenges such as shortage of staff, lack of specialised health professionals (e.g., nutritionists, gynaecologists) and limited internet connectivity which hinders the sharing of digital clinical histories within health establishments and m-health initiatives [ 49 ]. Additionally, home births are still culturally preferred in some cases and still more than 20% of the population had their first ANC after 20 weeks of pregnancy [ 44 ]. Earlier detection of pregnancies is needed to prevent and control pregnancy complications such as gestational diabetes and preeclampsia.…”