Why Do Some Ethiopian Women Give Birth at Home after Receiving Antenatal Care? Phenomenological Study

Abstract

Background In Ethiopia, majority (62%) of pregnant women receive at least one antenatal follow-up, yet only 26% give birth in health facility. Understanding factors underlying this high uptake of antenatal care and low institutional delivery service is critical. Women had antenatal care follow-up means; by default they have access to health facilities. Thus, why do some give birth at home even after receiving antenatal care? Methods. Fourteen key informant interviews and six focused group discussions were held among purposively selected women who gave birth in the last 12 months without skilled attendance after receiving antenatal care. The study explored women's perspectives on maternity care, care providers, and factors that influence place of delivery. Interpretative phenomenological analysis was used to examine various behaviors and beliefs of respondents. Results Study participants described range of experiences and beliefs that made them give birth at home after receiving antenatal care at health facilities. Four themes emerged from women's description: poor counseling during antenatal care service, traditions, early pregnancy symptoms, and lack of planning in advance for childbirth. Conclusion Poor counseling during antenatal care is deterring women from seeking skilled attendance at birth. Thus, healthcare providers need to stress necessity of facility based delivery care during antenatal follow-up counseling.

Disrespect and Abuse during Childbirth in Ethiopia: A Systematic Review

“…Notwithstanding their status, women have the right to obtain equal treatment, free from discrimination, and equitable care during childbirth [ 1 ] [ 1 ]; however, in Ethiopia they are not equal to those rights on the ground. The impact of these bad experiences has led many Ethiopia women to choose traditional birth attendants than skilled birth attendants; believed that the former regards you with sympathy, concerns with culture and still treats them with irrespective of their status [ 57 ].…”

Factors determining choice of place of delivery: analytical cross-sectional study of mothers in Akordet town, Eritrea

“…[48] This seems like mothers who go to ANC during the end of the pregnancy are doing so, to check their status before deciding the place of delivery, as it was found in a phenomenological study of home delivery conducted in Ethiopia. [52]…”

Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives’ perceptions

“…Although some efforts are in place by the Ethiopian government to increase the quantity of higher level health workers to meet the country’s demand – and indeed the early success in scaling up of HEWs has paved the way for more costly initiatives, such as scaling up midwives [13, 30] – the capacity and readiness of higher education institutions to assure quality education has not developed proportionally to its growth in numbers [3]. Many women in Ethiopia still give birth in the home, attended by non-skilled personnel such as traditional birth attendants, family members or neighbours [9].…”

“…The percentage of women who received ANC from a skilled attendant has increased from 27% in 2000 to 62% in 2016, while the percentage of live births delivered at a health facility increased markedly from just 5% in 2000 to 26% in 2016 [8]. Despite these improvements, however, the substantial gap between ANC attendance and facility births is one indication of the need to investigate health promotion initiatives and the delivery of ANC [9].…”