Women's preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery

Kruk, Margaret E; Paczkowski, Magdalena; Tegegn, Ayalew; Tessema, Fasil; Hadley, Craig; Asefa, Makonnen; Galea, Sandro

doi:10.1136/jech.2009.087973

Cited by 72 publications

(89 citation statements)

References 29 publications

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“…Traditionally, relatives are expected to be with the laboring mother to support, encourage her and pray for safe delivery. This finding is similar to the results of other studies [18, 20–22, 28, 29]. …”

Section: Discussionsupporting

confidence: 93%

Why do women not deliver in health facilities: a qualitative study of the community perspectives in south central Ethiopia?

et al. 2014

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BackgroundIn Ethiopia most childbirth occurs at home and is not assisted by skilled birth attendants. On the other hand having a birth attendant with midwifery skills during child birth is one of the most important interventions in reducing maternal morbidity and mortality. The objective of this study was to make an in-depth assessment of reasons why mothers do not use health facilities for child delivery.MethodsFocus Group Discussions were used to gather information on use of health facilities for delivery in Butajira districts of South Central Ethiopia. The study was conducted from January to February 2012. Information was collected from four groups of women who had delivered in the past two years and four groups of men whose wives/partners have delivered in the same period. Data was coded and categorized using open code, qualitative data management software and analyzed based on thematic analysis.ResultsA total of eight FGD sessions, four with women and four with men groups were conducted involving 81 residents of the Butajira district. FGD participants answered that a large majority of women in the district gave birth at home. Two major themes, client related factors and facility/staff factors, emerged. Factors that emerged within major themes of client factors were decision making on place of delivery, reliance on Traditional Birth Attendants (TBAs), misconception about services provided at health facility, inability of family members to be present at time of labor and delivery, lack of privacy, traditional and/or spiritual factors, economic factors and accessibility to health care facilities. Within major themes of facility/staff factors subthemes that emerged were poor reception, refusal of admission, lack of privacy, information gap, poor competence and shortage of staff and materials at health facilities.ConclusionWomen in the study areas do not deliver in health facilities because of reasons that can be attributed to health care system and client related factors. These need to be addressed by considering the specific factors related to the health system and community perspectives.

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Section: Discussionsupporting

confidence: 93%

Why do women not deliver in health facilities: a qualitative study of the community perspectives in south central Ethiopia?

et al. 2014

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“…Although this survey covered a limited set of provider-related newborn care practices, and is based on mothers’ recall rather than observations or interviews with service providers, the results suggest that providers may not always be following recommended newborn care practices or providing sufficient counseling for women on how to care for their newborns. The need for improvement in quality of maternal and newborn care is also highlighted by facility-based studies [34], and perceived low quality of care is reported as a reason that women in Ethiopia choose not to deliver at a health facility [35,36]. …”

Section: Discussionmentioning

confidence: 99%

Newborn care practices at home and in health facilities in 4 regions of Ethiopia

Callaghan-Koru

Seifu²,

Tholandi³

et al. 2013

BMC Pediatr

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BackgroundEthiopia is one of the ten countries with the highest number of neonatal deaths globally, and only 1 in 10 women deliver with a skilled attendant. Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can be delivered in communities as well as facilities. This article describes newborn care practices reported by recently-delivered women (RDWs) in four regions of Ethiopia.MethodsWe conducted a household survey with two-stage cluster sampling to assess newborn care practices among women who delivered a live baby in the period 1 to 7 months prior to data collection.ResultsThe majority of women made one antenatal care (ANC) visit to a health facility, although less than half made four or more visits and women were most likely to deliver their babies at home. About one-fifth of RDWs in this survey had contact with Health Extension Workers (HEWS) during ANC, but nurse/midwives were the most common providers, and few women had postnatal contact with any health provider. Common beneficial newborn care practices included exclusive breastfeeding (87.6%), wrapping the baby before delivery of the placenta (82.3%), and dry cord care (65.2%). Practices contrary to WHO recommendations that were reported in this population of recent mothers include bathing during the first 24 hours of life (74.7%), application of butter and other substances to the cord (19.9%), and discarding of colostrum milk (44.5%). The results suggest that there are not large differences for most essential newborn care indicators between facility and home deliveries, with the exception of delayed bathing and skin-to-skin care.ConclusionsImproving newborn care and newborn health outcomes in Ethiopia will likely require a multifaceted approach. Given low facility delivery rates, community-based promotion of preventive newborn care practices, which has been effective in other settings, is an important strategy. For this strategy to be successful, the coverage of counseling delivered by HEWs and other community volunteers should be increased.

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“…In Ghana, low facility utilization was attributed to physical abuse, verbal abuse, neglect and discrimination by healthcare providers [22]. Provider attitude had a large influence on decisions to have facility childbirth in Tanzania and Ethiopia [23, 24]. In Malawi women perceived respect, privacy and confidentiality as important aspects of care, although, they did not seem to be critical about the treatment component [25].…”

Section: Discussionmentioning

confidence: 99%

‘Born before arrival’: user and provider perspectives on health facility childbirths in Kapiri Mposhi district, Zambia

Phiri

Fýlkesnes

Ruano

et al. 2014

BMC Pregnancy Childbirth

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BackgroundMaternal mortality remains high in sub-Saharan Africa. Health facility intra-partum strategies with skilled birth attendance have been shown to be most effective to address maternal mortality. In Zambia, the health policy for pregnant women is to have facility childbirth, but less than half of the women utilize the facilities for delivery. ‘Born before arrival’ (BBA) describes childbirth that occurs outside health facility. With the aim to increase our understanding of trust in facility birth care we explored how users and providers perceived the low utilization of health facilities during childbirth.MethodsA qualitative study was conducted in Kapiri Mposhi, Zambia. Focus group discussions with antenatal clinic and outpatient department attendees were conducted in 2008 as part of the Response to Accountable priority setting and Trust in health systems project, (REACT). In-depth interviews conducted with women who delivered at home, their husbands, community leaders, traditional birth attendants, and midwives were added in 2011. Information was collected on perceptions and experiences of home and health facility childbirth, and reasons for not utilizing a facility at delivery. Data were analysed by inductive content analysis.ResultsPerspectives of users and providers were grouped under themes that included experiences related to promotion of facility childbirth, responsiveness of health care providers, and giving birth at home. Trust and quality of care were important when individuals seek facility childbirth. Safety, privacy and confidentiality encouraged facility childbirth. Poor attitudes of health providers, long distances and lack of transport to facilities, costs to buy delivery kits, and cultural ideals that local herbs speed up labour and women should exhibit endurance at childbirth discouraged facility childbirth.ConclusionTrust and perceived quality of care were important and influenced health care seeking at childbirth. Interventions that include both the demand and supply sides of services with prioritizing needs of the community could substantially improve trust and utilization of facilities at childbirth, and accelerate efforts to achieve MDG5.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-323) contains supplementary material, which is available to authorized users.

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Women's preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery

Cited by 72 publications

References 29 publications

Why do women not deliver in health facilities: a qualitative study of the community perspectives in south central Ethiopia?

Why do women not deliver in health facilities: a qualitative study of the community perspectives in south central Ethiopia?

Newborn care practices at home and in health facilities in 4 regions of Ethiopia

‘Born before arrival’: user and provider perspectives on health facility childbirths in Kapiri Mposhi district, Zambia

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