Preferences for formal and traditional sources of childbirth and postnatal care among women in rural Africa: A systematic review

Abstract

BackgroundThe underutilization of formal, evidence-based maternal health services continues to contribute to poor maternal outcomes among women living in rural Africa. Women’s choice of the type of maternal care they receive strongly influences their utilization of maternal health services. There is therefore a need to understand rural women’s preferred choices to help set priorities for initiatives attempting to make formal maternal care more responsive to women’s needs. The aim of this review was to explore and identify women’s preferences for different sources of childbirth and postnatal care and the factors that contribute to these preferences.MethodsA systematic literature search was conducted using the Ovid Medline, Embase, CINAHL, and Global Health databases. Thirty-seven studies that elicited women’s preferences for childbirth and postnatal care using qualitative methods were included in the review. A narrative synthesis was conducted to collate study findings and to report on patterns identified across findings.ResultsDuring the intrapartum period, preferences varied across communities, with some studies reporting preferences for traditional childbirth with traditional care-takers, and others reporting preferences for a formal facility-based childbirth with health professionals. During the postpartum period, the majority of relevant studies reported a preference for traditional postnatal services involving traditional rituals and customs. The factors that influenced the reported preferences were related to the perceived need for formal or traditional care providers, accessibility to maternal care, and cultural and religious norms.ConclusionReview findings identified a variety of preferences for sources of maternal care from intrapartum to postpartum. Future interventions aiming to improve access and utilization of evidence-based maternal healthcare services across rural Africa should first identify major challenges and priority needs of target populations and communities through formative research. Evidence-based services that meet rural women’s specific needs and expectations will increase the utilization of formal care and ultimately improve maternal outcomes across rural Africa.

Perceived differences on the role of traditional birth attendants in rural Tanzania: a qualitative study

“…A literature review on Asian traditional beliefs and practices also described that cultural beliefs can influence women's use of formal maternal healthcare services, and that women's fear of unnecessary medical interventions was a barrier to institutional births [26]. In a review of childbirth and postnatal care in rural Africa, the authors found that the influencing factors of people's preferences regarding formal or traditional healthcare were related to perceived attitudes toward healthcare providers, accessibility to maternal care, and respect for cultural and religious norms [27]. The study also demonstrated that women across rural Africa prefer to receive childbirth care from caring, considerate, and sympathetic providers, and that this population group sees cruel, insensitive, and degrading attendants as increasing negative maternal experiences and outcomes.…”

“…The study also demonstrated that women across rural Africa prefer to receive childbirth care from caring, considerate, and sympathetic providers, and that this population group sees cruel, insensitive, and degrading attendants as increasing negative maternal experiences and outcomes. A final remark from the cited study highlighted that the trust rural African women have in TBAs influenced the type of healthcare service they sought [27].…”

Mothers’ Experiences and Perceptions of Facility-based Delivery Care in Rural Ethiopia

“… 30 Furthermore, the importance of religious beliefs and trust in God is emphasized in a systematic review in which researchers identified that women in rural areas in Africa preferred healthcare facilities where their religious beliefs were respected and religiously sensitive care was provided. 31 Understanding the patient’s cultural context and the importance of religious and spiritual factors are important process elements in PCC 5 including the level of healthcare, which can be improved by providing a supportive environment, respectful care, and an open and trusting dialog between women and midwives, even when resources are scarce. Safe, respectful, and compassionate care is important.…”

Traditional birth attendants’ experiences during the provision of post-natal care in Mopani District, Limpopo province of South Africa

“…Despite the accessibility and affordability of maternal and neonatal care services, some women still prefer assistance of TBAs during pregnancy, labour, childbirth and puerperium (Chi & Urdal 2018 ; Mulenga et al 2018 ; Ngomane & Mulaudzi 2012 ). The preference and choice of maternity care by pregnant women is influenced by factors such as cultural beliefs, long distance to the nearest health facilities, disrespectful and abusive maternity care and friendliness of TBAs (Adatara et al 2018 ; Fantaye, Gunawardena & Yaya 2019 ; Gurara et al 2019 ; Mulenga et al 2018 ). In Burundi and Northern Uganda, TBAs were selected as the first point of consultation by many pregnant women in times of crisis (Chi & Urdal 2018 ).…”

“…In Nigeria, the TBAs were also involved in the provision of maternal and child health services as health promoters (Sulayman & Adaji 2019). In contrast, other women prefer hospital-based maternal healthcare services during pregnancy, labour and puerperium because of their religious beliefs (Fantaye et al 2019).…”