Understanding women’s decision-making process for birth location in Tanzania based on individual women’s reproductive pathways: a life-course perspective

Abstract

Background Determinants for women’s care seeking for birth in low-income setting are multifactorial and remain poorly understood. A life course approach can assist to structure the interplay of the different factors that lead to women seeking care or not. Objective In this study we aimed to explore individual women’s reproductive pathways, and increase understanding of how important life events including previous pregnancy and birth experiences can help us to understand individual choices made for care seeking during childbirth. Methods The study took place in Tanzania between 2015 and 2017. 14 women were followed throughout their pregnancy, birth and postpartum period through participant observation and in-depth interviews. In total 94 in-depth interviews were held (between 5–7 interviews per woman). Analysis occurred continuous throughout the data collection period resulting in detailed narratives of crucial events across women’s life course, with specific attention to their current pregnancy. Results Of the 14 women, seven had a facility birth, six a home birth and one woman gave birth at the home of a local birth attendant. Four different story plots were identified: expected home birth, expected facility birth, unexpected facility birth and unexpected home birth. Birth narratives of four women representative of the different story plots are presented. Narratives illustrate women’s individual reproductive pathways including the various factors influencing women’s expectations and justifications for their actions during their pregnancy and birth. Conclusion Women’s agency, including women’s perception of self, the self in relation to the social environment and reflection on risks associated with the range of options, influences the final decision made for birth. Women’s narratives suggest that quality of care can function as a primary pull factor for facility birth. As long as home birth is by some perceived to be a better alternative, achieving skilled care for all will be difficult to achieve.

Women’s autonomy and maternal health decision making in Kenya: implications for service delivery reform - a qualitative study

“…Thus, individual agency elevated perceived self-efficacy in their decision making. Choices about individual women’s reproductive pathways and decision-making for care seeking therefore depended their perception of self; the self in relation to social environment and reflection on risks associated with the decision to seek care or not [ 36 ]. Social identity influences decision-making practices of individuals emphasizing the importance of deliberately embracing diversity and promoting inclusion future in the design of interventions and reforms with a focus on.…”

The role of women’s autonomy and empowerment in maternal health decision making: Implications on the implementation process of a service delivery reform in Kenya. A qualitative exploratory study

“…Research has shown that individual women's reproductive pathways and decision-making for care seeking depends on their perception of self; the self in relation to social environment and re ection on risks associated with the decision to seek care or not (30). Therefore, social identity in uences decisionmaking practices of individuals emphasizing the importance of deliberately embracing diversity and promoting inclusion future in the design of interventions and reforms with a focus on.…”

Second Victims in Maternity Care – The Hidden Fallout of Parental Birth Plans

“…They tell us what things are permitted, what observations or examinations can be performed, and what interventions can be offered. They may even tell us what we can or cannot say, who can come into the room and who can't, sometimes going as far as to prevent the medical team entirely [11]. This is not new, though the passion for upholding it may seem so.…”