Why some women who attend focused antenatal care fail to deliver in health facilities: a qualitative study of women’s perspectives from slums of Addis Ababa, Ethiopia

Sendo, Endalew Gemechu; Chauke, Motshedisi E.; Ganga-Limando, Makombo

doi:10.1136/bmjopen-2020-039189

Cited by 9 publications

(11 citation statements)

References 33 publications

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“…Therefore, women recommend that more delivery beds (couches), medicines, and medical facilities, such as ultrasound exams, should be made available. The results of the research are consistent with prior studies [ 6 , 9 ].…”

Section: Discussionsupporting

confidence: 92%

“…A similar study in Lagos, Nigeria [ 31 ], and Addis Ababa Slums in Ethiopia [ 6 ] showed a financial barrier to women living in urban poor populations using health facilities for delivery care. Policymakers and government authorities should take note of our findings to provide skilled delivery care in neglected metropolitan areas.…”

Section: Discussionmentioning

confidence: 99%

“…Referring a patient is a medical decision determined by many factors, including the skills of the referring staff, the tools for diagnosis, the availability of a health institution with specialist facilities, the quality of care at the referral institution, the cost of care, distance, transportation, communication, someone to travel with the patient, and feasibility of travel by the client [ 14 , 15 ]. In the previous report, delays in obtaining access to referral services were seen as a major factor leading to feto-maternal deaths [ 6 , 16 ]. The same authors suggest oversight of care providers and increasing transparency and suggest evaluations of referrals for obstetric emergencies to strengthen obstetric care referral processes to avoid delays.…”

Section: Discussionmentioning

confidence: 99%

“…A slum household is described in this study as a community of people living under the same roof who lack one or more of the following conditions: access to improved water, living on small business/daily labor, access to improved sanitation, adequate living space, and durability of housing. The study included Ketchne and Kolfe Keraniyo slum dwellers, who are primarily low-income residential residents [ 6 ].…”

Section: Methodsmentioning

confidence: 99%

“…Key measures to enhance maternal health are the availability of a qualified birth attendant (SBA) during childbirth, readily available emergency services, and reliable communication and referral systems [ 5 ]. There may be an unduly higher risk of maternal mortality among women living in the slums of Addis Ababa, the capital city of Ethiopia [ 6 ]. The urban slums are a particularly vulnerable community, with inadequate housing, a lack of essential utilities, and low usage of skilled care during childbirth.…”

Section: Introductionmentioning

confidence: 99%

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Women’s perspectives on the measures that need to be taken to increase the use of health-care facility delivery service among slums women, Addis Ababa, Ethiopia: a qualitative study

2021

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Background Global strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery along with access to emergency obstetric care. Research that examines strategies to increase facility-based skilled birth attendance among slum residents in Addis Ababa, Ethiopia, is limited. Objective The study aimed to explore women's perspectives on the measures that need to be taken to increase the use of the facility—delivery service among slums women, Addis Ababa, Ethiopia Methods Qualitative exploratory and descriptive research designs were used. Participants in the study were women in the reproductive age group (18–49 years of age) living in the slum areas of Addis Ababa, Ethiopia. A purposive sampling strategy was used to select study participants. Potential participants' names were gathered from health facilities and followed to their homes for the study. Four audio-recorded focus group discussions [FGDs] were conducted with 32 participants from the three public health centers and one district hospital. The number of participants in FGDs was between 6 and 10 women. Data were analyzed simultaneously with data collection. Thematic analysis was used in data analysis, which entails three interconnected stages: data reduction, data display, and data conclusion. In addition, thematic analysis entailed evaluating the structure and content of textual data, identifying data themes, coding the themes, and then interpreting the structure and content of the themes. A codebook was first devised, discussed, and adopted by the writers before they could use this technique. Using the codebook, the theme codes were then manually produced. To explain the study results, verbatim excerpts from participants were given. The researcher used Techs' eight steps of qualitative data analysis method for analyzing the data. A multi-level life-course framework of facility-based delivery in low- and middle-income countries (LMICs) developed by Bohren et al. was used to frame the current study and link the findings of the study to the body of knowledge. Results The FGDs included a total of 32 participants. The mean age of the overall sample was 32.6 years (± SD = 5.2). Participants' educational characteristics indicate that the majority (24 out of 32) was found to have no formal education, and two-thirds of participants were found to have one to five children. Three-fourths of them attended the ANC twice and they all gave birth to their last child at home. Two themes emerged from the analysis of focus group data, namely provision of quality, respectful and dignified midwifery care, and lack of awareness about facility delivery. These themes were described as a rich and comprehensive account of the views and suggestions made by focused antenatal care [FANC] participants on measures required to improve the use of the facility-delivery services. The findings of the study raise concerns about the effectiveness of FANC in encouraging facility-deliveries since FANC participants had not used health facilities for their last childbirth. According to the findings of the focus groups, women who took part in this study identified measures required to increase the use of health facility-delivery services among FANC participants in Addis Ababa's slum residents. It is to be expected that diligent counseling during antenatal care about birth plans would facilitate prompt arrival at facilities consistent with the desires of women.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%