Factors affecting the choice of delivery place in a rural area in Laos: A qualitative analysis

Abstract

Background Home delivery (HD) without skilled birth attendants (SBAs) are considered crucial risk factors increasing maternal and child mortality rates in Loa PDR. While a few studies in the literature discuss the choice of delivery in remote areas of minority ethnic groups; our work aims to identify factors that indicated their delivery place, at home or in the health facilities. Methods A community-based qualitative study was conducted between February and March 2020. Three types of interviews were implemented, In-depth interviews with 16 women of eight rural villages who delivered in the last 12 months in Xepon District, Savannakhet Province, Lao PDR. Also, three focus group discussions (FGDs) with nine HCPs and key-informant interviews of ten VHVs were managed. Factors affecting the choice of the delivery place were categorized according to the social-ecological model. Results Our sample included five Tri women and two Mangkong women in the HD group, while the FD group included three Tri women, two Mangkong women, one Phoutai woman, two Laolung women and one Vietnamese. Our investigation inside the targeted minority showed that both positive perceptions of home delivery (HD) and low-risk perception minorities were the main reasons for the choice of HD, on the individual level. On the other hand, fear of complication, the experience of stillbirth, and prolonged labour pain during HD were reasons for facility-based delivery (FD). Notably, the women in our minority reported no link between their preference and their language, while the HCPs dated the low knowledge to the language barrier. On the interpersonal level, the FD women had better communication with their families, and better preparation for delivery compared to the HD group. The FD family prepared cash and transportation using their social network. At the community level, the trend of the delivery place had shifted from HD to FD. Improved accessibility and increased knowledge through community health education were the factors of the trend. At the societal (national policy) level, the free delivery policy and limitation of HCPs’ assisted childbirth only in health facilities were the factors of increasing FD, while the absence of other incentives like transportation and food allowance was the factor of remaining of HD. Conclusions Based on the main findings of this study, we urge the enhancement of family communication on birth preparedness and birthplace. Furthermore, our findings support the need to educate mothers, especially those of younger ages, about their best options regarding the place of delivery. We propose implementing secondary services of HD to minimize the emergency risks of HD. We encourage local authorities to be aware of the medical needs of the community especially those of pregnant females and their right for a free delivery policy.

Factors influencing maternal death in Cambodia, Laos, Myanmar, and Vietnam countries: A systematic review

“…Furthermore, rather than financial constraints, the delay in seeking care or the first delay that could lead to the mother's death was heavily influenced by certain social and cultural beliefs. Pregnant women's lack of empowerment, the influence of spiritual healers, a close relationship with traditional birth attendance, and medication misuse were all important factors in the delay in seeking care [18,29,[33][34][35]. It was also discovered a culture in some ethnic groups that may lead to maternal death, in which pregnant women had to go into a forest for their births, where births were performed by themselves or with the assistance of their husbands, and then spend three days afterwards [21].…”

“…It was also reported that the majority of rural mother deaths were caused by a lack of access to skilled birth attendance and unskilled and incorrect management of traditional birth attendance, as well as the consequences of birth-related complications being more prevalent among rural pregnant women managed by unskilled birth attendance [22,36,45]. Contrary to popular belief, wealthy pregnancies had higher demand for HIV testing, Syphilis testing, ultrasound screening, skilled birth attendance, high-quality antenatal care services, and institutional deliveries [17,33].…”

“…It was also claimed that the trained birth attendance (TBA) handled pregnancy and childbirth complications in an unscientific and unsafe manner, which could result in maternal deaths [18]. Maternal deaths were found to be affected by the entry of new healthcare providers (e.g., fresher Mid-wives with less expertise on childbirth and revision of maternal complications), the lack of experience during births (e.g., less one year of service), the lack of continuous medical education, and the low quality of basic healthcare providers [28,33,58,59].…”

Perspectives of Healthcare Providers in Maternal and Child Health Services in BokeoProvince, Lao People’s Democratic Republic: A Qualitative Study

“…In 2012, approximately 42% of child deliveries were attended by healthcare providers at home, primary healthcare facilities, or hospitals. However, routine maternal and child health (MCH) reporting indicates that a significant number of mothers who die during childbirth do not have access to health services and give birth at home (Kawaguchi et al, 2021). This research received budget support from the Lancang-Mekong Cooperation Special Fund (People's Republic of China), contributing to improving the MCH system in Remote Areas Bordering Thailand-Lao PDR.…”

Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care

“…Several studies have examined aspects of socioeconomic status (SES) that are associated with deterrence of facility-based childbirth in low-income settings, but few have quantitatively examined contributory factors [9][10][11][12][13][14][15]. In Kenya, efforts to encourage more women particularly those from rural and low SES communities to give birth in health facilities -including free maternal health services, health education, and ease of facility access-have been implemented, yet some women still do not give birth in health facilities [16].…”