Reasons for low level of skilled birth attendance in Afar pastoralist community, North East Ethiopia: a qualitative exploration

Abstract

IntroductionEthiopia has expanded the number of health facilities that offer maternal health services during the last two decades. However, the utilization of skilled birth attendants in health facilities is still very low especially among the pastoralist regions of the country. This study explored why women in the pastoralist region of Afar, Ethiopia still prefer to give birth at home.MethodsA qualitative study approach was used to collect information from October to December 2015. A total of eighteen focus group discussions and twenty-four key informant interviews were conducted. Focus group discussions were separately conducted with mothers and male tribal or religious leaders. Key informant interviews were conducted with heads of Women's Affairs Bureau, district health office heads and traditional birth attendants. Data were coded and categorized using open code software for qualitative data management and analyzed based on a thematic approach.ResultsWomen preferred to deliver at home due to lack of awareness about the benefits of maternity health facilities, their nomadic lifestyle, lack of confidence and trust in health workers and their close affinity and easy access to traditional birth attendants. Supply-side barriers included distant health facilities, lack of transportation and poor health care.ConclusionDemand and supply related factors were identified as barriers to utilization of skilled birth attendants. Increasing awareness, bringing the service closer, arranging maternity waiting area around health facilities, and creating client-friendly service were found critical. Future research to define and improve services and approaches suitable for pastoralist population is warranted.

Health interventions among mobile pastoralists: a systematic review to guide health service design

“…Among reports included in this review, interventions that deliberately incorporated a pastoralist‐specific delivery strategy reported higher levels of success in reaching pastoralist communities. Methods ranged from strategically located services (‘temporary fixed’) to fully mobile services [17,38,67–70]. Additional strategies included maternal waiting homes, mobile TB ‘manyatta’ camps and One Health design [15,27,28,54,67,70,71].…”

“…Methods ranged from strategically located services (‘temporary fixed’) to fully mobile services [17,38,67–70]. Additional strategies included maternal waiting homes, mobile TB ‘manyatta’ camps and One Health design [15,27,28,54,67,70,71]. While mobile campaigns described success in reaching the target population, only five presented data on cost and resource utilisation.…”

“…Overall, One Health initiatives appear to be a promising approach with the potential to improve community acceptance, intervention coverage and cost efficacy [27,28,28,54]. Given that supply‐side failures such as shortages of trained personnel, medications and equipment were frequently cited barriers to intervention success, resource efficiency is a critical consideration [47,67,72,73]. Partnership between public health and veterinary sectors may be an effective way of addressing this challenge and may also improve community engagement and attitudes towards health interventions given the high social and economic value placed by pastoralists on their livestock [74,75].…”

Why do some countries do better or worse in life expectancy relative to income? An analysis of Brazil, Ethiopia, and the United States of America

“…Kebeles share a health centre that services 25,000–40,000 people and coordinates the health posts [ 41 ]. The number of health posts and health centres has increased from 76 and 412 in the early 1990s to 1600 and 3500 in 2015 respectively [ 42 , 43 ]. One core component of PHC in Ethiopia has been the Health Extension Program that provides routine house-to-house visits to deliver four principal strategies (disease prevention and control, family health services, hygiene and environmental sanitation, and health education and communication) by deploying community-based health workers (mostly women), called Health Extension Workers (HEWs), who are given 1 year of training [ 44 , 45 ].…”

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

“…The greater household responsibilities of multiparous women compared to nulliparous and primiparous women, including caring for multiple children, could contribute to their preferences to stay home for maternal care. In several rural communities, women with some formal education mainly preferred formal childbirth care and PNC under the guidance of HCPs [38, 49, 54, 56, 58, 63]. This may have been due to greater knowledge, awareness, and understanding of the risks of maternity and the significance of professionally trained attendants in reducing poor maternal and neonatal outcomes.…”