Why do women not use skilled birth attendance service? An explorative qualitative study in north West Ethiopia

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(2020) 20:633

RESEARCH ARTICLE

Open Access

Why do women not use skilled birth attendance service? An explorative qualitative study in north West Ethiopia Biruhtesfa Bekele Shiferaw1,2* and Lebitsi Maud Modiba1,2

Abstract Background: Having a birth attendant with midwifery skills during childbirth is an effective intervention to reduce maternal and early neonatal morbidity and mortality. Nevertheless, many women in Ethiopia still deliver a baby at home. The current study aimed at exploring and describing reasons why women do not use skilled delivery care in North West Ethiopia. Methods: This descriptive explorative qualitative research was done in two districts of West Gojjam Zone in North West Ethiopia. Fourteen focus group discussions (FGDs) were conducted with pregnant women and mothers who delivered within one year. An inductive thematic analysis approach was employed to analyse the qualitative data. The data analysis adhered to reading, coding, displaying, reducing, and interpreting data analysis steps. Results: Two major themes client-related factors and health system-related factors emerged. Factors that emerged within the major theme of client-related were socio-cultural factors, fear of health facility childbirth, the nature of labour, lack of antenatal care (ANC) during pregnancy, lack of health facility childbirth experience, low knowledge and poor early care-seeking behaviour. Under the major theme of health system-related factors, the sub-themes that emerged were low quality of service, lack of respectful care, and inaccessibility of health facility. Conclusions: This study identified a myriad of supply-side and client-related factors as reasons given by pregnant women, for not giving birth in health institution. These factors should be redressed by considering the specific supply-side and community perspectives. The results of this study provide evidence that could help policymakers to develop strategies to address barriers identified, and improve utilisation of skilled delivery service. Keywords: Home delivery, Skilled delivery service, Health system-related factors, Maternal mortality, Client-related factors, Ethiopia

Background Globally, the maternal mortality ratio (MMR) reduced by 38%, that is from 342/100,000 live births in 2000 to 211/100,000 live births in 2017. However, 295,000 maternal deaths occurred in 2017 worldwide. Unsurprisingly, developing countries accounted for about 86% of * Correspondence: [email protected] 1 Department of Health Studies, University of South Africa, Addis Ababa, Ethiopia 2 Department of Health Studies, University of South Africa, Pretoria, South Africa

the estimated maternal deaths in the same year, with sub-Saharan countries alone accounting for 66% of the maternal deaths [1]. Likewise, though the MMR in Ethiopia reduced substantially from 871 deaths/100,000 live births to 412 deaths/100,000 live births between 2000 and 2016, the MMR is still very high [2]. The overwhelming maternal deaths happened due to haemorrhage, hypertensive disorders, sepsis,