W422 THE CHANGING ROLE OF TBAs IN SIERRA LEONE: FROM BIRTH ATTENDANT TO FACILITY BIRTH PROMOTER?

Herschderfer, K.; Koning, Koen de; Jalloh-Vos, Heidi; Walker, Patrick

doi:10.1016/s0020-7292(12)62143-2

Cited by 2 publications

(21 citation statements)

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“…Most women in Sierra Leone belong to a secret society, where girls are initiated into womanhood making them eligible for marriage [ 43 ]. During this rite of passage from childhood to womanhood, women are circumcised and educated about pregnancy and childbirth [ 15 , 27 ]. The word secret is taken literally as women are not meant to discuss what takes place during the initiations with those who have not undergone the initiation themselves [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies conducted in Sierra Leone identified prohibitive costs to be one of the main barriers for women accessing maternal health care and utilising facilities during childbirth [ 15 - 17 ]. In 2010, in response to these findings, the government of Sierra Leone introduced the Free Health Care Initiative (FHCI) for pregnant women, breastfeeding mothers and children under the age of 5 [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…In 2010, in response to these findings, the government of Sierra Leone introduced the Free Health Care Initiative (FHCI) for pregnant women, breastfeeding mothers and children under the age of 5 [ 18 ]. A local-level initiative has also been introduced in the form of ‘bylaws’ [ 15 ]. The bylaws are described as a way to stimulate ‘facility care’ , implying that women are required to attend antenatal care and give birth at a facility.…”

Section: Introductionmentioning

confidence: 99%

“…The bylaws are described as a way to stimulate ‘facility care’ , implying that women are required to attend antenatal care and give birth at a facility. The laws are put in place by local authorities (typically chiefs), and women, husbands and occasionally Traditional Birth Attendants (TBA) can be fined if they do not comply [ 15 ]. The role that these laws actually play in local communities remains unknown.…”

Section: Introductionmentioning

confidence: 99%

“…Researchers have increasingly considered the experiences, perceptions, preferences and perceived risks of the ‘service-user’ during pregnancy and delivery to gain a deeper understanding of both decision-making processes and health-seeking behaviour within specific contexts [ 23 - 27 ]. Studies conducted before the introduction of FHCI in Sierra Leone found that barriers to accessing care at health facilities included prohibitive and unreliable costs, geographic inaccessibility, distance, lack of transport, and lack of supplies and human resources [ 15 - 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Exploration of perceptions and decision-making processes related to childbirth in rural Sierra Leone

Treacy

Sagbakken

2015

BMC Pregnancy Childbirth

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BackgroundMaternal mortality ratio (MMR) remains high in Sierra Leone. Efforts have been made to reduce MMR by increasing the number of women delivering at a health facility through introduction of the Free Health Care Initiative in 2010. Despite this, utilisation remains lower than aimed for, with marked inequalities between rural and urban settings. This study explores the perceptions and decision-making processes of women and their communities during childbirth in rural Sierra Leone.MethodsA qualitative, cross-sectional study employing focus group discussions, in- depth interviews and informal interviews with pregnant women and community members in rural northern Sierra Leone. Data were analysed using systematic text condensation.ResultsData revealed that the decision-making processes are complex and multi-faceted. Decisions regarding the place of delivery and with whom assisting the birth are often made collectively. A normal delivery is seen as one that occurs within the village. Previous experiences, perceptions and expressions of bodily symptoms as well as the interpretation of different risks affect these decisions. The health seeking behaviours were found to be flexible and dynamic, and the final decisions about where to give birth could be governed by unexpected circumstances.ConclusionsDecision-making processes during childbirth in rural Sierra Leone are dynamic and intricate and need to be understood within the broader social context. Future initiatives to improve access and utilisation of safe health services for pregnant women within rural Sierra Leone need to be based on adequate knowledge of women’s preferences, cultural-specific traits, capabilities, perceptions of risk and the constraints in which they may live.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exploration of perceptions and decision-making processes related to childbirth in rural Sierra Leone

Treacy

Sagbakken

2015

BMC Pregnancy Childbirth

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Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study

2018

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BackgroundSierra Leone has one of the highest maternal mortality ratios in the world. Efforts to reduce maternal mortality have included initiatives to encourage more women to deliver at health facilities. Despite the introduction of the free health care initiative for pregnant women, many women still continue to deliver at home, with few having access to a skilled birth attendant. In addition, inequalities between rural and urban areas in accessing and utilising health facilities persist. Further insight into how and why women make decisions around childbirth will help guide future plans and initiatives in improving maternal health in Sierra Leone. The objective of this study was to explore the perceptions and decision-making processes of women and their communities during childbirth in rural Sierra Leone.Methods and findingsData were collected through seven focus group discussions and 22 in-depth interviews with recently pregnant women and their community members in two rural villages. Data were analysed using systematic text condensation. Findings revealed that decision-making processes during childbirth are dynamic, intricate and need to be understood within the broader social context that they take place. Factors such as distance and lack of transport, perceived negative behaviour of hospital staff, direct and indirect financial obstacles, as well as the position of women in society all interact and influence how and what decisions are made.ConclusionsPregnant women face multiple interacting vulnerabilities that influence their healthcare-seeking decisions during pregnancy and childbirth. Future initiatives to improve access and utilisation of safe healthcare services for pregnant women need to be based on adequate knowledge of structural constraints and health inequities that affect women in rural Sierra Leone.

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W422 THE CHANGING ROLE OF TBAs IN SIERRA LEONE: FROM BIRTH ATTENDANT TO FACILITY BIRTH PROMOTER?

Cited by 2 publications

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Exploration of perceptions and decision-making processes related to childbirth in rural Sierra Leone

Exploration of perceptions and decision-making processes related to childbirth in rural Sierra Leone

Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study

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