Life saving or money wasting?

Parkhurst, Justin; Rahman, Syed Azizur

doi:10.1016/j.healthpol.2006.03.015

Cited by 25 publications

(18 citation statements)

References 15 publications

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“…The combination of unfavorable attitudes towards cesarean section [108-112] and the frequent need for repeat cesarean delivery in subsequent pregnancies due to recurrent dystocia and the risk that the uterine scar may rupture during labor, means that many women have already been told that if they have the operation they will need a repeat cesarean later. Dissatisfaction with earlier experiences may contribute to delay until catastrophe strikes.…”

Section: Discussionmentioning

confidence: 99%

Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

Wall

2012

BMC Pregnancy Childbirth

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BackgroundAn obstetric fistula is a traumatic childbirth injury that occurs when labor is obstructed and delivery is delayed. Prolonged obstructed labor leads to the destruction of the tissues that normally separate the bladder from the vagina and creates a passageway (fistula) through which urine leaks continuously. Women with a fistula become social outcasts. Universal high-quality maternity care has eliminated the obstetric fistula in wealthy countries, but millions of women in resource-poor nations still experience prolonged labor and tens of thousands of new fistula sufferers are added to the millions of pre-existing cases each year. This article discusses fistula prevention in developing countries, focusing on the factors which delay treatment of prolonged labor.DiscussionObstetric fistulas can be prevented through contraception, avoiding obstructed labor, or improving outcomes for women who develop obstructed labor. Contraception is of little use to women who are already pregnant and there is no reliable screening test to predict obstruction in advance of labor. Improving the outcome of obstructed labor depends on prompt diagnosis and timely intervention (usually by cesarean section). Because obstetric fistulas are caused by tissue compression, the time interval from obstruction to delivery is critical. This time interval is often extended by delays in deciding to seek care, delays in arriving at a hospital, and delays in accessing treatment after arrival. Communities can reasonably demand that governments and healthcare institutions improve the second (transportation) and third (treatment) phases of delay. Initial delays in seeking hospital care are caused by failure to recognize that labor is prolonged, confusion concerning what should be done (often the result of competing therapeutic pathways), lack of women’s agency, unfamiliarity with and fear of hospitals and the treatments they offer (especially surgery), and economic constraints on access to care.SummaryWomen in resource-poor countries will use institutional obstetric care when the services provided are valued more than the competing choices offered by a pluralistic medical system. The key to obstetric fistula prevention is competent obstetrical care delivered respectfully, promptly, and at affordable cost. The utilization of these services is driven largely by trust.

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Section: Discussionmentioning

confidence: 99%

Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

Wall

2012

BMC Pregnancy Childbirth

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“…A compelling reason for deterring or delaying the use of health services or refusing a caesarean section is the cost involved (18,27,28), which is beyond the means of poor families and far greater than expenses incurred by the study women who experienced severe complications but delivered vaginally, or for those with normal deliveries, particularly those that occur at home (29). The majority of the families of women who had a caesarean section spent over Tk 14,999 (US$ 217), approximately one-third of the annual GDP per capita in Bangladesh (30).…”

Section: Discussionmentioning

confidence: 99%

“…Families also expressed scepticism about the health provider's reason for recommending a caesarean section, with many believing that they were prescribing the procedure for their economic gains rather than medical reasons. Results of another study in Bangladesh also showed distrust in the recommendations of doctors due to perceptions that caesarean sections were being administered for personal gain, a conviction which served to dissuade women from visiting a health facility out of fear that a caesarean section might be unnecessarily performed and high costs incurred (28). Overall, the negative perceptions identified in this study about the physical and social consequences associated with caesarean section influenced many women and their families to refuse the procedure initially, even when they suffered life-threatening complications.…”

Section: Discussionmentioning

confidence: 99%

An Examination of Women Experiencing Obstetric Complications Requiring Emergency Care: Perceptions and Sociocultural Consequences of Caesarean Sections in Bangladesh

Khan

Blum

Sultana

et al. 2012

J Health Popul Nutr

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Little is known about the physical and socioeconomic postpartum consequences of women who experience obstetric complications and require emergency obstetric care (EmOC), particularly in resource-poor countries such as Bangladesh where historically there has been a strong cultural preference for births at home. Recent increases in the use of skilled birth attendants show socioeconomic disparities in access to emergency obstetric services, highlighting the need to examine birthing preparation and perceptions of EmOC, including caesarean sections. Twenty women who delivered at a hospital and were identified by physicians as having severe obstetric complications during delivery or immediately thereafter were selected to participate in this qualitative study. Purposive sampling was used for selecting the women. The study was carried out in Matlab, Bangladesh, during March 2008–August 2009. Data-collection methods included in-depth interviews with women and, whenever possible, their family members. The results showed that the women were poorly informed before delivery about pregnancy-related complications and medical indications for emergency care. Barriers to care-seeking at emergency obstetric facilities and acceptance of lifesaving care were related to apprehensions about the physical consequences and social stigma, resulting from hospital procedures and financial concerns. The respondents held many misconceptions about caesarean sections and distrust regarding the reason for recommending the procedure by the healthcare providers. Women who had caesarean sections incurred high costs that led to economic burdens on family members, and the blame was attributed to the woman. The postpartum health consequences reported by the women were generally left untreated. The data underscore the importance of educating women and their families about pregnancy-related complications and preparing families for the possibility of caesarean section. At the same time, the health systems need to be strengthened to ensure that all women in clinical need of lifesaving obstetric surgery access quality EmOC services rapidly and, once in a facility, can obtain a caesarean section promptly, if needed. While greater access to surgical interventions may be lifesaving, policy-makers need to institute mechanisms to discourage the over-medicalization of childbirth in a context where the use of caesarean section is rapidly rising.

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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%

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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Life saving or money wasting?

Cited by 25 publications

References 15 publications

Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

An Examination of Women Experiencing Obstetric Complications Requiring Emergency Care: Perceptions and Sociocultural Consequences of Caesarean Sections in Bangladesh

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

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