Abstract
BackgroundIn many low-income countries women tend to deliver at home, and delays in receiving appropriate maternal care can be fatal. A contextual understanding of these delays is important if countries are to meet development targets for maternal health. We present qualitative research with women who delivered at home in rural Nepal, to gain a contemporary understanding of the context where we are testing the effectiveness of an intervention to increase institutional deliveries.MethodsWe purposively sampled women who had recently delivered at home and interviewed them to explore their reasons for home delivery. Interviews were recorded, transcribed and analysed using thematic content analysis. We used the ‘delays’ model discussed in the literature to frame our analysis.ResultsUsually a combination of factors prevented women from delivering in health institutions. Many women were aware of the benefits of institutional delivery yet their status in the home restricted their access to health facilities. Often they did not wish to bring shame on their family by going against their wishes, or through showing their body in a health institution. They often felt unable to demand the organisation of transportation because this may cause financial problems for their family. Some felt that government incentives were insufficient. Often, a lack of family support at the time of delivery meant that women delivered at home. Past bad experience, and poor quality health services, also prevented women from having an institutional delivery.ConclusionsFormative research is important to develop an understanding of local context. Sociocultural issues, perceived accessibility of health services, and perceived quality of care were all important barriers preventing institutional delivery. Targeting one factor alone may not be effective in increasing institutional deliveries. Our intervention encourages communities to develop local responses to address the factors preventing institutional delivery through women’s groups and improved health facility management. We will monitor perceptions of health services over time to help us understand the effectiveness of the intervention.
Highlights
In many low-income countries women tend to deliver at home, and delays in receiving appropriate maternal care can be fatal
Progress is being made towards the Millennium Development Goal (MDG) of reducing maternal mortality by 75% by the year 2015
Newborn mortality has been slow to respond to MDG efforts, and recent analysis suggests that 41% of deaths in children under five
Summary
In many low-income countries women tend to deliver at home, and delays in receiving appropriate maternal care can be fatal. The Government of Nepal is trying to address human resource challenges in providing maternal and newborn care, for example through establishing targets for enrolling health workers in the Skilled Birth Attendant training course It is encouraging periphery level health facilities to provide 24 hour delivery services, beyond the normal opening hours of 10 am to 2 pm. These Government policies demonstrate commitment to address the barriers to institutional delivery, and indicate that the policy environment may be receptive to other low cost interventions that may reduce delays in care seeking
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