Abstract
Despite improvements in maternal mortality globally, hundreds of women continue to die daily. The World Health Organisation therefore advises all women in low-and-middle income countries to give birth in healthcare facilities. Barriers to seeking intrapartum care have been described in Thaddeus and Maine's Three Delays Model, however these decisions are complex and often unique to different settings. Loreto, a rural province in Peru has one of the highest homebirth rates in the country at 31.8%. The aim of this study was to explore facilitators and barriers to facility births and explore women's experiences of intrapartum care in Amazonian Peru. Through purposive sampling, postnatal women were recruited for semi-structured interviews (n = 25). Interviews were transcribed verbatim and thematically analysed. A combination of deductive and inductive coding was used. Analytical triangulation was undertaken, and data saturation was used to determine when no further interviews were necessary. Five themes were generated from the data: 1) Financial barriers; 2) Accessing care; 3) Fear of healthcare facilities; 4) Importance of seeking care and 5) Comfort and traditions of home. Generally, participants realised the importance of seeking skilled care however barriers persisted, across all areas of the Three Delays Model. Barriers identified included fear of healthcare facilities and interventions, direct and indirect costs, continuation of daily activities, distance and availability of transport. Women who delivered in healthcare facilities had mixed experiences, many reporting good attention, however a selection experienced poor treatment including abusive behaviour. Despite free care, women continue to face barriers seeking obstetric care in Amazonian Peru, including fear of hospitals, cost and availability of transport. However, women accessing care do not always receive positive care experiences highlighting implications for changes in accessibility and provision of care. Minimising these barriers is critical to improve maternal and neonatal outcomes in rural Peru.
Highlights
Despite advances in recent years, maternal mortality remains a major global issue
Barriers to seeking intrapartum care have been described in Thaddeus and Maine’s Three Delays Model, these decisions are complex and often unique to different settings
Five themes were generated from the data: 1) Financial barriers; 2) Accessing care; 3) Fear of healthcare facilities; 4) Importance of seeking care and 5) Comfort and traditions of home
Summary
Despite advances in recent years, maternal mortality remains a major global issue. The maternal mortality rate (MMR) is defined as the number of maternal deaths per 100,000 live births, caused by conditions related to or aggravated by pregnancy [1]. Despite aspirations within the Millennium Development Goals (MDGs) to reduce MMR by 75% by 2015, only a 38% reduction was achieved, and hundreds of women continue to die daily [2,3,4] Many of these deaths are preventable, highlighting the importance of high quality antenatal and intrapartum care (IPC) [5]. The World Health Organisation (WHO) state that all women have a right to access high quality care during pregnancy and parturition, less than half of births in low and middle-income countries (LMIC) are attended by healthcare professionals [6, 7] Preventing these deaths is a key priority for the WHO, addressing inequalities in access to and quality of maternity services [6, 8]. The aim of this study was to explore facilitators and barriers to facility births and explore women’s experiences of intrapartum care in Amazonian Peru
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