Birth location preferences of mothers and fathers in rural Ghana: Implications for pregnancy, labor and birth outcomes.

Leslie E Cofie,Clare Barrington,Akalpa Akaligaung,Kavita Singh,Sodzi Sodzi-Tettey

doi:10.1186/s12884-015-0604-2

Leslie E Cofie, Clare Barrington + Show 3 more

Open Access

https://doi.org/10.1186/s12884-015-0604-2

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Abstract

BackgroundMaternal deaths in Sub-Saharan Africa are largely preventable with health facility delivery assisted by skilled birth attendants. Examining associations of birth location preferences on pregnant women’s experiences is important to understanding delays in care seeking in the event of complications. We explored the influence of birth location preference on women’s pregnancy, labor and birth outcomes.MethodsA qualitative study conducted in rural Ghana consisted of birth narratives of mothers (n = 20) who experienced pregnancy/labor complications, and fathers (n = 18) whose partners experienced such complications in their last pregnancy. All but two women in our sample delivered in a health facility due to complications. We developed narrative summaries of each interview and iteratively coded the interviews. We then analyzed the data through coding summaries and developed analytic matrices from coded transcripts.ResultsBirth delivery location preferences were split for mothers (home delivery–9; facility delivery–11), and fathers (home delivery–7; facility delivery–11). We identified two patterns of preferences and birth outcomes: 1) preference for homebirth that resulted in delayed care seeking and was likely associated with several cases of stillbirths and postpartum morbidities; 2) Preference for health facility birth that resulted in early care seeking, and possibly enabled women to avoid adverse effects of birth complications.ConclusionSafe pregnancy and childbirth interventions should be tailored to the birth location preferences of mothers and fathers, and should include education on the development of birth preparedness plans to access timely delivery related care. Improving access to and the quality of care at health facilities will also be crucial to facilitating use of facility-based delivery care in rural Ghana.

Highlights

Maternal deaths in Sub-Saharan Africa are largely preventable with health facility delivery assisted by skilled birth attendants
In low- and middle-income countries (LMICs) like Ghana pregnant women living in rural areas may fail to seek health facility delivery care until the onset of labor complications, presenting in facilities too late to be helped [8,9,10]
Among the 38 participants interviewed preference for homebirths and health facility births were split among mothers and more fathers preferred facility over home delivery (Fig. 1)

Summary

Introduction

Maternal deaths in Sub-Saharan Africa are largely preventable with health facility delivery assisted by skilled birth attendants. Examining associations of birth location preferences on pregnant women’s experiences is important to understanding delays in care seeking in the event of complications. Half of the world’s maternal deaths occur in Sub-Saharan Africa, mostly as a result of complications including hemorrhage, eclampsia, obstructed labor, and infections [1,2,3]. Many of these deaths would be largely prevented with health facility delivery assisted by skilled birth attendants (SBAs) [4, 5].

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