Abstract
BackgroundMaternal mortality ratio (MMR) remains high in Sierra Leone. Efforts have been made to reduce MMR by increasing the number of women delivering at a health facility through introduction of the Free Health Care Initiative in 2010. Despite this, utilisation remains lower than aimed for, with marked inequalities between rural and urban settings. This study explores the perceptions and decision-making processes of women and their communities during childbirth in rural Sierra Leone.MethodsA qualitative, cross-sectional study employing focus group discussions, in- depth interviews and informal interviews with pregnant women and community members in rural northern Sierra Leone. Data were analysed using systematic text condensation.ResultsData revealed that the decision-making processes are complex and multi-faceted. Decisions regarding the place of delivery and with whom assisting the birth are often made collectively. A normal delivery is seen as one that occurs within the village. Previous experiences, perceptions and expressions of bodily symptoms as well as the interpretation of different risks affect these decisions. The health seeking behaviours were found to be flexible and dynamic, and the final decisions about where to give birth could be governed by unexpected circumstances.ConclusionsDecision-making processes during childbirth in rural Sierra Leone are dynamic and intricate and need to be understood within the broader social context. Future initiatives to improve access and utilisation of safe health services for pregnant women within rural Sierra Leone need to be based on adequate knowledge of women’s preferences, cultural-specific traits, capabilities, perceptions of risk and the constraints in which they may live.
Highlights
Introduction of the Free Health CareInitiative has been a positive and significant approach towards improving access to healthcare for pregnant women
The aim of this study is to explore the perceptions and decision-making processes related to childbirth in rural Sierra Leone
Data were collected through focus group discussions (FGDs) and individual and group in-depth interviews (IDIs) with recently pregnant women and members of their communities
Summary
Introduction of the Free Health CareInitiative has been a positive and significant approach towards improving access to healthcare for pregnant women. Maternal mortality ratio (MMR) remains high in Sierra Leone. Efforts have been made to reduce MMR by increasing the number of women delivering at a health facility through introduction of the Free Health Care Initiative in 2010. There seems to be an international consensus that increasing the proportion of women delivering with skilled attendance will improve maternal health by reducing. Oyerinde et al recommended an increase in health facility delivery as among the measures to reduce maternal mortality [12]. This strategy was advocated by the government in 2009 [13,14]
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