Sociocultural determinants of home delivery in Ethiopia: a qualitative study

Kaba, Mirgissa; Bulto, Tesfaye; Tafesse, Zergu; Lingerh, Wassie; Ismael, Ali K.

doi:10.2147/ijwh.s98722

Cited by 41 publications

(49 citation statements)

References 18 publications

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“…Many Ethiopians argue that birth is a natural life event that is supposed to take place at home. In their view, a health facility should only come into play when labour is complicated [ 23 , 24 ]. Since in 20% of low-risk pregnancies complications occur that require treatment, MWHs also target women from remote areas [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with intended use of a maternity waiting home in Southern Ethiopia: a community-based cross-sectional study

Vermeiden

Braat

Medhin

et al. 2018

BMC Pregnancy Childbirth

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BackgroundAlthough Ethiopia is scaling up Maternity Waiting Homes (MWHs) to reduce maternal and perinatal mortality, women’s use of MWHs varies markedly between facilities. To maximize MWH utilization, it is essential that policymakers are aware of supportive and inhibitory factors. This study had the objective to describe factors and perceived barriers associated with potential utilization of an MWH among recently delivered and pregnant women in Southern Ethiopia.MethodsA community-based cross-sectional study was conducted between March and November 2014 among 428 recently delivered and pregnant women in the Eastern Gurage Zone, Southern Ethiopia, where an MWH was established for high-risk pregnant women to await onset of labour. The structured questionnaire contained questions regarding possible determinants and barriers. Logistic regression with 95% Confidence Intervals (CI) was used to examine association of selected variables with potential MWH use.ResultsWhile only thirty women (7.0%) had heard of MWHs prior to the study, 236 (55.1%), after being explained the concept, indicated that they intended to stay at such a structure in the future. The most important factors associated with intended MWH use in the bivariate analysis were a woman’s education (secondary school or higher vs. no schooling: odds ratio [OR] 6.3 [95% CI 3.46 to 11.37]), her husband’s education (secondary school or higher vs. no schooling: OR 5.4 [95% CI 3.21 to 9.06]) and envisioning relatively few barriers to MWH use (OR 0.32 [95% CI 0.25 to 0.39]). After adjusting for possible confounders, potential users had more frequently suffered complications in previous childbirths (adjusted odds ratio [aOR] 4.0 [95% CI 1.13 to 13.99]) and envisioned fewer barriers to MWH use (aOR 0.3 [95% CI 0.23 to 0.38]). Barriers to utilization included being away from the household (aOR 18.1 [95% CI 5.62 to 58.46]) and having children in the household cared for by the community during a woman’s absence (aOR 9.3 [95% CI 2.67 to 32.65]).ConclusionsMost respondents had no knowledge about MWHs. Having had complications during past births and envisioning few barriers were factors found to be positively associated with intended MWH use. Unless community awareness of preventive maternity care increases and barriers for women to stay at MWHs are overcome, these facilities will continue to be underutilized, especially among marginalized women.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1670-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Factors associated with intended use of a maternity waiting home in Southern Ethiopia: a community-based cross-sectional study

Vermeiden

Braat

Medhin

et al. 2018

BMC Pregnancy Childbirth

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“…Although the current study lacked data to infer on the precise reasons underlying greater reporting of such factors, particularly in Ethiopia, there was a related study which highlighted the concept of considering delivery as a natural phenomenon versus a health ailment requiring health facility services in Ethiopia. This study also elaborated on the pleasure, women receive from rituals following home delivery [ 29 ]. On the other hand in the Nigerian context lack of education has been cited as the underlying factor behind the “Not necessary/Not customary” reports of health facility delivery and further that planning health facility delivery in advance reduces such reports [ 30 , 31 ] Lack of awareness/misconception of the importance of health facility delivery and socio-cultural factors have been cited in previous research studies consistent with the findings of the current study [ 32 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria

et al. 2018

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BackgroundObstetric complications and maternal deaths can be prevented through safe delivery process. Facility based delivery significantly reduces maternal mortality by increasing women’s access to skilled personnel attendance. However, in sub-Saharan Africa, most deliveries take place without skilled attendants and outside health facilities. Utilization of facility-based delivery is affected by socio-cultural norms and several other factors including cost, long distance, accessibility and availability of quality services. This study examined country-level variations of the self-reported causes of not choosing to deliver at a health facility.MethodsCross-sectional data on 37,086 community dwelling women aged between 15–49 years were collected from DHS surveys in Ethiopia (n = 13,053) and Nigeria (n = 24,033). Outcome variables were the self-reported causes of not delivering at health facilities which were regressed against selected sociodemographic and community level determinants. In total eight items complaints were identified for non-use of facility delivery: 1) Cost too much 2) Facility not open, 3) Too far/no transport, 4) don’t trust facility/poor service, 5) No female provider, 6) Husband/family didn’t allow, 7) Not necessary, 8) Not customary. Multivariable regression methods were used for measuring the associations.ResultsIn both countries a large proportion of the women mentioned facility delivery as not necessary, 54.9% (52.3–57.9) in Nigeria and 45.4% (42.0–47.5) in Ethiopia. Significant urban-rural variations were observed in the prevalence of the self-reported causes of non-utilisation. Women in the rural areas are more likely to report delivering at health facility as not customary/not necessary and healthy facility too far/no transport. However, urban women were more likely to complain that husband/family did not allow and that the costs were too high.ConclusionWomen in the rural were more likely to regard facility delivery as unnecessary and complain about transportation and financial difficulties. In order to achieving the maternal mortality related targets, addressing regional disparities in accessing maternal healthcare services should be regarded as a priority of health promotion programs in Nigeria and Ethiopia.

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“…Though current government reports showed an improvement in skilled attendance, from 10% in 2011 to 28% in 2016, [ 8 , 9 ] some women are giving their back to the service once experiencing it. As a result, improving maternal health remains important challenge to the nation [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Experience of Facility Based Childbirth in Rural Ethiopia: An Exploratory Study of Women’s Perspective

Adinew

Assefa

2017

Journal of Pregnancy

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Background In Ethiopia, majority (62%) of pregnant women attend antenatal care at least once, yet only 26% deliver with skilled birth attendants in the available health units. Thus, this study explored beliefs and behaviors related to labour and skilled attendance among the women, their perspectives on health care providers, and traditional birth attendants. Methods Sixteen key informant interviews and eight focus group discussions were conducted among purposively selected women who had previous experience of facility based childbirth but gave birth to their most recent child without skilled attendance in the last 12 months. Thematic content analysis was used to elicit and assess the various perspectives of each group of participants interviewed. Findings The study participants described a range of experiences they had during childbirth at health facilities that forced them to choose home delivery in their most recent delivery. Three themes and six subthemes emerging from women's description were abusive and disrespectful treatment, unskilled care, poor client provider interaction, noncontinuous care, lack of privacy, and traditional practices. Conclusion The abuse and disrespect from providers are deterring women from seeking skilled attendance at birth. Thus the health care providers need to improve client provider relationships.

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Sociocultural determinants of home delivery in Ethiopia: a qualitative study

Cited by 41 publications

References 18 publications

Factors associated with intended use of a maternity waiting home in Southern Ethiopia: a community-based cross-sectional study

Factors associated with intended use of a maternity waiting home in Southern Ethiopia: a community-based cross-sectional study

Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria

Experience of Facility Based Childbirth in Rural Ethiopia: An Exploratory Study of Women’s Perspective

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