Barriers to Uptake of Emergency Obstetric and Newborn Care Services in Sierra Leone: A Qualitative Study

Oyerinde, Koyejo; Harding, Yvonne; Amara, Philip S.; Garbrah-Aidoo, Nana; Kanu, Rugiatu; Oulare, Macoura; Shoo, Rumishael; Daoh, Kizito

doi:10.4172/2161-0711.1000149

Cited by 32 publications

(50 citation statements)

References 15 publications

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“…These women may fear mistreatment from heath workers for not possessing an ANC card or may avoid the facility due to poor experiences during ANC care. 14 Facilitator and barrier: Effects of previous birth experiences on subsequent delivery location [ 17 , 20 , 21 , 24 , 25 , 30 , 32 , 34 , 36 , 39 , 44 , 46 , 47 ] High confidence In general, studies were moderately well done. Diverse findings were seen across many studies and settings.…”

Section: Methodsmentioning

confidence: 99%

“…Even if women are able to arrange transportation during the off-hours, health facilities may be closed or lack the staffing to manage her delivery. 24 Barrier: Delays in accessing referral services [ 17 , 29 , 34 , 45 , 49 ] Moderate confidence In general, studies were moderately well done. The finding was seen across several studies and settings.…”

Section: Methodsmentioning

confidence: 99%

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Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis

et al. 2014

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High-quality obstetric delivery in a health facility reduces maternal and perinatal morbidity and mortality. This systematic review synthesizes qualitative evidence related to the facilitators and barriers to delivering at health facilities in low- and middle-income countries. We aim to provide a useful framework for better understanding how various factors influence the decision-making process and the ultimate location of delivery at a facility or elsewhere. We conducted a qualitative evidence synthesis using a thematic analysis. Searches were conducted in PubMed, CINAHL and gray literature databases. Study quality was evaluated using the CASP checklist. The confidence in the findings was assessed using the CERQual method. Thirty-four studies from 17 countries were included. Findings were organized under four broad themes: (1) perceptions of pregnancy and childbirth; (2) influence of sociocultural context and care experiences; (3) resource availability and access; (4) perceptions of quality of care. Key barriers to facility-based delivery include traditional and familial influences, distance to the facility, cost of delivery, and low perceived quality of care and fear of discrimination during facility-based delivery. The emphasis placed on increasing facility-based deliveries by public health entities has led women and their families to believe that childbirth has become medicalized and dehumanized. When faced with the prospect of facility birth, women in low- and middle-income countries may fear various undesirable procedures, and may prefer to deliver at home with a traditional birth attendant. Given the abundant reports of disrespectful and abusive obstetric care highlighted by this synthesis, future research should focus on achieving respectful, non-abusive, and high-quality obstetric care for all women. Funding for this project was provided by The United States Agency for International Development (USAID) and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization.Electronic supplementary materialThe online version of this article (doi:10.1186/1742-4755-11-71) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis

et al. 2014

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“…Research has shown that women who perceive receiving substandard and disrespectful care during childbirth are far less likely to seek future facilty-based birth care which places them and their newborns at risk [4][5][6]. Moreover, women with negative experiences may also discourage others from seeking facility-based care [7]. Moreover, vulnerable women in lower social economic positions are at a greater risk to experience disrespectful care despite existing professional standards and documented policies with respect to delivery of care, even among High Income Countries (HICs) where legal consequences for violations in providing care exist and patients are aware of their rights [8].…”

Section: Introductionmentioning

confidence: 99%

Deliver on Your Own: Disrespectful Maternity Care in rural Kenya

et al. 2020

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BackgroundUnder the Free Maternity Policy (FMP), Kenya has witnessed an increase in health facility deliveries rather than home deliveries with Traditional Birth Attendants (TBA) resulting in improved maternal and neonatal outcomes. Despite these gains, maternal and infant mortality and morbidity rates in Kenya remain unacceptably high indicating that more needs to be done. AimUsing data from the Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project's qualitative gender assessment, this paper examines women's experience of disrespectful care during pregnancy, labour, and delivery. The goal is to promote an improved understanding of the actual care conditions to inform the development of interventions that can lift the standard of care, increase maternity facility use, and improve health outcomes for both women and newborns. MethodologyWe conducted sixteen focus group discussions (FGDs), two each for adolescent females, adult females, adult males, and community health committee members. As well, twenty-four key Informants interviews (KII) were also conducted including religious leaders, and persons from local government representatives, Ministry of Health (MOH), and local women's organizations. Data were captured through audio recordings and reflective field notes. Research siteKisii and Kilifi Counties in Kenya. PLOS ONE | https://doi.org/10.1371/journal.pone. Data Availability Statement:Data from this study are available upon request. This is due to ethical reasons. The study involved 24 key informant interviews (KIIs) and 16 focus group discussions with female adolescents, women, men, and members of community health committees. The KIIs were held (12 at each site) with two health service providers, two community health care workers, two local religious leaders, two local government representatives, two Ministry of Health representatives, and two representatives of local women's organizations. It is possible for someone from the study sites to deduce whom the Findings Findings show nursing and medical care during labour and delivery were at times disrespectful, humiliating, uncompassionate, neglectful, or abusive. In both counties, male health workers were preferred by women giving birth, as they were perceived as more friendly and sensitive. Adolescent females were more likely to report abuse during maternity care while women with disabled children reported being stigmatized. Structural barriers related to transportation and available resources at facilities associated with disrespectful care were identified.

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“…Furthermore, in some societies, the perceived quality of care from traditional birth attendants may be higher than in a facility because women are treated respectfully in familiar environments and with more privacy [24,25]. Attendant staff shortages and a lack of infrastructure in health facilities can also deepen perceptions of low quality of care delivered in the health facilities and act as deterrents [23,26].…”

Section: Introductionmentioning

confidence: 99%

Community-level factors associated with the use of facility-based delivery assistance in Uganda: a multilevel analysis

Micah

Hotchkiss

2020

BMC Pregnancy Childbirth

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Background: In low-and middle-income countries, the proportion of pregnant women who use health facilities for delivery remains low. Although delivering in a health facility with skilled health providers can make the critical difference between survival and death for both mother and child, in 2016, more than 25% of pregnant women did not deliver in a health facility in Uganda. This study examines the association of contextual factors measured at the community-level with use of facility-based delivery in Uganda, after controlling for household and individual-level factors. Methods: Pooled household level data of 3310 observations of women who gave birth in the last five years is linked to community level data from the Uganda National Panel Survey (UNPS). A multilevel model that adequately accounted for the clustered nature of the data and the binary outcome of whether or not the woman delivered in a health facility was estimated. Results: The study findings show a positive association at the county level between place of delivery, education and access to health services, and a negative association between place of delivery and poverty. Individuals living in communities with a high level of education amongst the household heads were 1.67 times (95% Confidence Interval: 1.07-2.61) more likely to have had a facility-based delivery compared to women living in communities where household heads did not have high levels of education. Women who lived in counties with a short travel time (less than 33 min) were 1.66 times (95% CI: 1.11-2.48) more likely to have had a facility-based delivery compared to women who lived in counties with longer travel time to any health facility. Women living in poor counties were only 0.64 times (95% CI: 0.42-0.97) as likely to have delivered in a health facility compared to pregnant women from communities with more affluent individuals. Conclusions: The findings on household head's education, community economic status and travel time to a health facility are useful for defining the attributes for targeting and developing relevant nationwide community-level health promotion campaigns. However, limited evidence was found in broad support of the role of community level factors.

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Barriers to Uptake of Emergency Obstetric and Newborn Care Services in Sierra Leone: A Qualitative Study

Cited by 32 publications

References 15 publications

Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis

Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis

Deliver on Your Own: Disrespectful Maternity Care in rural Kenya

Community-level factors associated with the use of facility-based delivery assistance in Uganda: a multilevel analysis

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