Why do women not deliver in health facilities: a qualitative study of the community perspectives in south central Ethiopia?

Roro, Meselech; Hassen, Emebet Mahmoud; Lemma, Alemayehu; Gebreyesus, Seifu Hagos; Afework, Mesganaw Fantahun

doi:10.1186/1756-0500-7-556

Cited by 78 publications

(92 citation statements)

References 19 publications

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“…For example, in Ethiopia, delivery at health institutions costs $17–22, while home delivery with traditional birth attendants costs only $0.8. Consequently, poor families may choose not to use SBA during deliveries [38]. Secondly, travel costs and foregone earnings are important opportunity costs in consuming health services for the poorest households, especially those living in remote rural areas.…”

Section: Discussionmentioning

confidence: 99%

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Subramanian

et al. 2017

Global Health Action

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Background: Reducing child mortality was one of the Millennium Development Goals. In the current Sustainable Development Goals era, achieving equity is prioritized as a major aim. Objective: This study aims to provide a comprehensive and updated picture of inequalities in child health intervention coverage and child health outcomes by wealth status, as well as their trends between 2000 and 2014. Methods: Using data from Demographic Health Surveys and Multiple Indicator Cluster Surveys, we adopted three measures of inequality, including one absolute inequality indicator and two relative inequality indicators, to estimate the level and trends of inequalities in three child health outcome variables and 17 intervention coverages in 88 developing countries. Results: While improvements in child health outcomes and coverage of interventions have been observed between 2000 and 2014, large inequalities remain. There was a high level of variation between countries’ progress toward reducing child health inequalities, with some countries significantly improving, some deteriorating, and some remaining statistically unchanged. Among child health interventions, the least equitable one was access to improved sanitation (The absolute difference in coverages between the richest quintile and the poorest quintile reached 49.5% [42.7, 56.2]), followed by access to improved water (34.1% [29.5, 38.6]), and skilled birth attendant (SBA) (34.1% [28.8, 39.4]). The most equitable intervention coverage was insecticide-treated bed net for children (1.0% [−3.9, 5.9]), followed by oral rehydration therapy for diarrhea ((8.0% [5.2, 10.8]), and vitamin A supplement (8.4% [5.1, 11.7]). These findings were robust to various inequality measurements. Conclusions: Although child health outcomes and coverage of interventions have improved largely over the study period for almost all wealth quintiles, insufficient progress was made in reducing child health inequalities between the poorest and richest wealth quintiles. Future efforts should focus on reaching the poorest children by increasing investments toward expanding the coverage of interventions in resource-limited settings.

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Section: Discussionmentioning

confidence: 99%

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Subramanian

et al. 2017

Global Health Action

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“…Gitimu and colleagues [26] reported in a study in Kenya that only 40.3 % of births were attended by skilled personnel. Meselech et al found in a qualitative study in South Central Ethiopia that majority of women gave birth at home and home delivery is taken as a common practice [27]. This difference could be attributed to the differences in financial access to maternal health services.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason TBAs are encourage and are given incentives to refer all labouring women to the nearest health facility and therefore the trends of deliveries conducted by them are expected to decline [17]. Meselech et al, however concluded in their study that women relied on Traditional Birth Attendants for delivery as a result of varying reasons including cost of service [27]. …”

Section: Discussionmentioning

confidence: 99%

Linear trends and seasonality of births and perinatal outcomes in Upper East Region, Ghana from 2010 to 2014

Osei

Agbemefle

Kye-Duodu

et al. 2016

BMC Pregnancy Childbirth

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BackgroundSeasonal variations greatly influence birth patterns differently from country to country. In Ghana, there is paucity of information on birth seasonal patterns. This retrospective study described the trends and seasonality of births and perinatal outcomes in Upper East Region of Ghana.MethodsBirths occurring in each month of the calendar years (2010–2014; inclusive) were extracted from the District Health Information Management System (DHIMS2) database of the Bolgatanga Municipal Health Directorate and exported into Microsoft Excel spread sheet and Epi Ifo for analysis. Analysis was carried out by calculating average number of births per month correcting for unequal month length using 30 days. A Chi-square test for trend was performed to check for statistical significance (p < 0.05) in trends and seasonality of birth and perinatal outcomes.ResultsThere were 24,171 health facility deliveries, of which 97.7 % were singleton deliveries and 2.3 % were multiple (two or three) deliveries. There was a consistent rise in the annual health facility deliveries controlled for the number of fertile women, from 4169 in 2010 to 5474 in 2014 (p < 0.0001). Monthly birth distribution displayed a periodic pattern with peaks in May, September and October and troughs during the months of January, February and July (p < 0.0001). Women were likely to give birth during the raining season than the dry season. Caesarean Section (CS) rate showed a steady rise over the years (124 per 1000 births in 2010 to 185 per 1000 births in 2014 (p < 0.0001) with overall rate of 14.6 %. Stillbirth (SB) rate, however decreased slightly over the years from 29 per 1000 births to 23 per 1000 births (p = 0.197) with overall SB rate of 2.6 %. Similarly, Low Birth Weight (LBW) declined from 77 per 1000 live births to 71 per 1000 live births from 2010 to 2014 (p < 0.0001). Seasonal (rainy and dry) distributions did not show a clear difference in birth frequencies.ConclusionHealth facility delivery was persistently high in the Bolgatanga Municipality with birth peaking in May, September and October. Despite the rising rate of caesarean section, stillbirth rate did not significantly improved over the years. A prospective study may reveal the reasons for the increasing caesarean section rate. Additionally, understanding the factors that affect the decreasing trends of low birth weight in the municipality is crucial to public health policy makers in Ghana.

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“…Even though there are no costs for maternal services in public health facilities, it has been observed mothers spend money for transportation, food and purchase of drugs and supplies. These were important reasons for the low utilization of delivery services in other similar studies conducted in Ethiopia and other places as well [11,15,18,27,28]. Making sure essential supplies and drugs are available at all times and the mothers who come seeking the services return satisfied is critical to achieve higher coverage for maternity services.…”

Section: Discussionmentioning

confidence: 99%

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

Ibrhim¹,

Demissie²,

Medhanyie³

et al. 2018

Pan Afr Med J

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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.

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Why do women not deliver in health facilities: a qualitative study of the community perspectives in south central Ethiopia?

Cited by 78 publications

References 19 publications

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Assessing levels and trends of child health inequality in 88 developing countries: from 2000 to 2014

Linear trends and seasonality of births and perinatal outcomes in Upper East Region, Ghana from 2010 to 2014

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

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