Women’s perspectives on the measures that need to be taken to increase the use of health-care facility delivery service among slums women, Addis Ababa, Ethiopia: a qualitative study

Abstract

Background Global strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery along with access to emergency obstetric care. Research that examines strategies to increase facility-based skilled birth attendance among slum residents in Addis Ababa, Ethiopia, is limited. Objective The study aimed to explore women's perspectives on the measures that need to be taken to increase the use of the facility—delivery service among slums women, Addis Ababa, Ethiopia Methods Qualitative exploratory and descriptive research designs were used. Participants in the study were women in the reproductive age group (18–49 years of age) living in the slum areas of Addis Ababa, Ethiopia. A purposive sampling strategy was used to select study participants. Potential participants' names were gathered from health facilities and followed to their homes for the study. Four audio-recorded focus group discussions [FGDs] were conducted with 32 participants from the three public health centers and one district hospital. The number of participants in FGDs was between 6 and 10 women. Data were analyzed simultaneously with data collection. Thematic analysis was used in data analysis, which entails three interconnected stages: data reduction, data display, and data conclusion. In addition, thematic analysis entailed evaluating the structure and content of textual data, identifying data themes, coding the themes, and then interpreting the structure and content of the themes. A codebook was first devised, discussed, and adopted by the writers before they could use this technique. Using the codebook, the theme codes were then manually produced. To explain the study results, verbatim excerpts from participants were given. The researcher used Techs' eight steps of qualitative data analysis method for analyzing the data. A multi-level life-course framework of facility-based delivery in low- and middle-income countries (LMICs) developed by Bohren et al. was used to frame the current study and link the findings of the study to the body of knowledge. Results The FGDs included a total of 32 participants. The mean age of the overall sample was 32.6 years (± SD = 5.2). Participants' educational characteristics indicate that the majority (24 out of 32) was found to have no formal education, and two-thirds of participants were found to have one to five children. Three-fourths of them attended the ANC twice and they all gave birth to their last child at home. Two themes emerged from the analysis of focus group data, namely provision of quality, respectful and dignified midwifery care, and lack of awareness about facility delivery. These themes were described as a rich and comprehensive account of the views and suggestions made by focused antenatal care [FANC] participants on measures required to improve the use of the facility-delivery services. The findings of the study raise concerns about the effectiveness of FANC in encouraging facility-deliveries since FANC participants had not used health facilities for their last childbirth. According to the findings of the focus groups, women who took part in this study identified measures required to increase the use of health facility-delivery services among FANC participants in Addis Ababa's slum residents. It is to be expected that diligent counseling during antenatal care about birth plans would facilitate prompt arrival at facilities consistent with the desires of women.

Factors associated with accessing and utilisation of healthcare and provision of health services for residents of slums in low and middle-income countries: a scoping review of recent literature

“…Home remedy and home management delayed healthcare-seeking behaviour 52 70 81 84. In addition, perception,21 42 63 75 83 85–89 knowledge21 42 48 60 67 74 81 85 90–95 and experience of healthcare services39 49 59 61 66 69 74 79 86 96 97 including fear and distrust of healthcare services,21 38 67 71 74 75 78 88 98–100 and preference related to care provider’s gender87 101 were frequently cited factors. Provider shopping associated with distrust of healthcare providers and denial of diagnosis delayed first care seeking and treatment initiation of patients with pulmonary tuberculosis in India 70.…”

Intrapartum respectful maternity care practices and its barriers in Eastern India

“…[ 17 ] A community-based study in Ethiopia reported physical abuse of 23.2%,[ 21 ] higher than ours. However, other studies in the same country reported only 2% to 2.3% of physical or verbal abuse[ 1 22 ]; in some African studies, poor reporting could be because of a lack of awareness or perceived normalization of abuse. [ 9 ] In the present study, women reported 70.55% continuity of care, similar to study findings in Ethiopia.…”

“…However, 94.30% of our study participants reported non-confidential care, higher than those conducted in Addis Ababa, Ethiopia (16.3%). [ 1 ] The discrepancy may be due to faulty perception of women, poor communication of HCWs with women, overburden at work, insufficient space in the labor room, and shortage of HCWs. Women reported 9.45% non-dignified care in our study and 23.77% abandonment and denial of care, which was higher when compared to other studies in India[ 16 17 ] and abroad.…”

“…Quality health care imparted to a woman during pregnancy, delivery, and postpartum is crucial to ensure the mother and baby’s health to her most satisfaction. [ 1 ] The Indian government is making tremendous efforts by implementing various programs to promote institutional delivery for poor pregnant women by ensuring cost-effective skilled health care professionals to reduce maternal and infant mortalities and morbidities. [ 2 ] However, recent evidence suggests that these interventions did not have the desired impacts, with many maternal deaths, especially in poor-performing states, highlighting the need to improve the quality of care for institutional births.…”