Understanding home delivery in a context of user fee reduction: a cross-sectional mixed methods study in rural Burkina Faso

Abstract

BackgroundSeveral African countries have recently reduced/removed user fees for maternal care, producing considerable increases in the utilization of delivery services. Still, across settings, a conspicuous number of women continue to deliver at home. This study explores reasons for home delivery in rural Burkina Faso, where a successful user fee reduction policy is in place since 2007.MethodsThe study took place in the Nouna Health District and adopted a triangulation mixed methods design, combining quantitative and qualitative data collection and analysis methods. The quantitative component relied on use of data from the 2011 round of a panel household survey conducted on 1130 households. We collected data on utilization of delivery services from all women who had experienced a delivery in the previous twelve months and investigated factors associated with home delivery using multivariate logistic regression. The qualitative component relied on a series of open-ended interviews with 55 purposely selected households and 13 village leaders. We analyzed data using a mixture of inductive and deductive coding.ResultsOf the 420 women who reported a delivery, 47 (11 %) had delivered at home. Random effect multivariate logistic regression revealed a clear, albeit not significant trend for women from a lower socio-economic status and living outside an area to deliver at home. Distance to the health facility was found to be positively significantly associated with home delivery. Qualitative findings indicated that women and their households valued facility-based delivery above home delivery, suggesting that cultural factors do not shape the decision where to deliver. Qualitative findings confirmed that geographical access, defined in relation to the condition of the roads and the high transaction costs associated with travel, and the cost-sharing fees still applied at point of use represent two major barriers to access facility-based delivery.ConclusionsFindings suggest that the current policy in Burkina Faso, as similar policies in the region, should be expanded to remove fees at point of use completely and to incorporate benefits/solutions to support the transport of women in labor to the health facility in due time.

Study of the Factors Associated with Home Delivery in a Situation of Free Care in Senegal

“…The involvement of the Bajenou Gox Planning of delivery may be hampered by the position of the woman in the society. Her limited power of decision in household does not confer the ability to negotiate and to take some decisions [14] [20]. Planning of delivery is not often The situation is so alarming that the government has implemented a policy of free costs in caesarean delivery [11].…”

“…That's why the Senegalese authorities have decided to make deliveries and caesarean sections free of charge in all health facilities and hospitals outside the region of Dakar [11]. The determinants of home delivery in a context of gratuity are not well documented [12] [13] [14]. The results vary from one country to another [12] [13] [14].…”

“…The determinants of home delivery in a context of gratuity are not well documented [12] [13] [14]. The results vary from one country to another [12] [13] [14]. The aim of this work is to study the factors associated with the place of delivery in a situation of gratuity of delivery.…”

“ Who'll do all these if I'm not around?” : Bonding social capital and health and well-being of inpatients

“…Apparently, the critical role of BSC explains the call for a move away from individualistic focus in healthcare delivery to a more holistic approach—one that considers the broader social being of a person by incorporating their social ties in healthcare delivery (Levine & Zuckerman, 1999; Lewis et al, 2014). Nonetheless, it is equally vital to note that some relatives—as previous studies warn—tend to conflate or present their personal beliefs and values as that of inpatients (De Allegri et al, 2015; Mazer et al, 2014). They often do that by making healthcare decisions without recourse to the choice of the person in need when they have the opportunity to contribute and thereby potentially endangering the health of the sick (De Allegri et al, 2015; Mazer et al, 2014).…”

“…Nonetheless, it is equally vital to note that some relatives—as previous studies warn—tend to conflate or present their personal beliefs and values as that of inpatients (De Allegri et al, 2015; Mazer et al, 2014). They often do that by making healthcare decisions without recourse to the choice of the person in need when they have the opportunity to contribute and thereby potentially endangering the health of the sick (De Allegri et al, 2015; Mazer et al, 2014). Notwithstanding, studies indicate that people with chronic and severe health conditions for instance, actively rely on their family and friends for information and emotional support to manage their conditions and for companionship (Gilbar, 2011; Korfage et al, 2013; Levine & Zuckerman, 1999; Roddis et al, 2016).…”