Perceptions Matter: Barriers to Treatment of Postpartum Hemorrhage

Abstract

Postpartum hemorrhage is the leading cause of maternal deaths in developing countries. This report highlights the social and cultural factors that influence the decision to seek care in cases of postpartum bleeding. Survey data on awareness of danger signs in the postpartum period and findings from the anthropologic literature describing beliefs about bleeding in childbirth and the postpartum period are presented. Findings point to a mismatch between actual and perceived risks of danger in the postpartum period. This may reflect a viewpoint that there are few risks remaining after the baby is born. This may, in turn, shape the perception that the postpartum period is one in which less vigilance is required compared with labor and birth. Such beliefs are important to consider, as they may influence timely seeking of emergency obstetric care. Efforts to reduce the incidence of postpartum hemorrhage as a major cause of maternal death must progress on two fronts: on the supply side to ensure the provision of skilled care and on the demand side to ensure that women and their families accept the view that bleeding after birth is dangerous and that skilled care is preferable to traditional care.

Barriers to neonatal care in developing countries: Parents' and providers' perceptions

“…As half of neonatal deaths worldwide occur following home births, 12 increasing access to and the quality of neonatal care should be a priority to reduce neonatal mortality rates. However, improved perinatal morbidity and mortality cannot be expected unless programs can increase parents' care‐seeking, decrease delays in recognition of illness, facilitate more timely referrals for care and improve access to quality care at all levels 9,13,14 . Identification of barriers amenable to change is an important first step in developing locally feasible and affordable programs that could improve health‐care access and neonatal outcomes.…”

“…However, they are often not easily available in centres that lack technology, provider experience or economic means to implement and sustain interventions routinely utilised in the developed world 6,7 . Parents' perceptions of barriers to care also adversely impact the effectiveness of neonatal care programs developed for low‐income countries 8–10 …”

Cultural Theories of Postpartum Bleeding in Matlab, Bangladesh: Implications for Community Health Intervention

“…Returning to the Delay Model, a theoretical and practical issue raised in this study is the relative contribution of health-related beliefs, individual attributes, and socioecological constraints to care and care-seeking for obstetric emergencies. This represents a relatively-unexplored agendum in safe motherhood (8-9). Addressing this agendum is necessary if we are to improve programming to reduce maternal death and disability during the transition to skilled birth attendance for all women.…”

“…There is a paucity of research focusing on the first delay—decision to seek care in the event of PPH (8-9). To address this gap, during 2005-2006, the Center for Research on Maternal and Newborn Survival of Emory University and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) initiated a study among childbearing women and maternity-care providers in Matlab, Bangladesh.…”

Women's Perceptions of Childbirth Experience at a Hospital in Rural Tanzania

“…In sub-Saharan Africa the rate of births attended by skilled personnel is estimated to be less than 40% (WHO, 2005). For this reason, most previous research has focused on the barriers to delivery at a health facility for women who give birth at home and not on the experiences of women who come to a health facility for birth (Lori & Boyle, 2011;Mrisho et al, 2007;Thaddeus & Maine, 1994;Thaddeus, Nangalia, & Vivio, 2004).…”