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

Abstract

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.

Determinants of home delivery in Nepal – A disaggregated analysis of marginalised and non-marginalised women from the 2016 Nepal Demographic and Health Survey

“…The reason of not feeling necessary to deliver in health facilities contributed the highest proportion among both marginalised (64%) and non-marginalised women (35%). This might be because of lack of awareness and understanding among women regarding the consequences of delivering their child at home without a skilled attendant and the benefits of institutional delivery, or it might be because of socio-demographic or cultural factors as illustrated by the study from Nigeria and Ethiopia which suggested lower likelihood of considering facility delivery as unnecessary among women with higher educational level [51]. It might be partly a reflection of their perception of the quality of services being delivered in health facilities as there is notable proportion of women who visited health facilities for ANC services but delivered babies at home.…”

Prevalence of institutional delivery and its correlates amongst women of reproductive age in Mozambique: a cross-sectional analysis

“…The racial/ethnic differences in maternal health service use and health outcomes have been a subject of growing interest in many countries [34][35][36][37]. The underlying factors behind this difference generally consist of lower socioeconomic status and perception of health and healthcare [29,38]. In some cultures, delivering at home may be considered normal or more culturally appropriate, thereby making the practice more common even when professional birthing services are available [38].…”

“…The underlying factors behind this difference generally consist of lower socioeconomic status and perception of health and healthcare [29,38]. In some cultures, delivering at home may be considered normal or more culturally appropriate, thereby making the practice more common even when professional birthing services are available [38]. Sociocultural factors that shape healthcare-seeking behaviour are inherently more challenging to address and require special strategies such as replacing the existing norms and beliefs with the new ones through community education (role play) programs [39,40].…”

Improving Practice of Institutional Delivery in Southern Ethiopia

“…Available evidence revealed that several factors such as socio-economic status, maternal education, infrastructure, place of residence, women's experiences with healthcare providers and access to primary health care services significantly influence mothers' choice of place of delivery [13][14][15][16]. For example, a study from Nigeria and Ethiopia showed that women in the rural areas were more likely to regard facility delivery as unimportant and also complained about distance and inability to pay for the services [17].…”