Rethinking How to Promote Maternity Care-Seeking: Factors Associated With Institutional Delivery in Guinea

Ellen Brazier,Renée Fiorentino,Saidou Barry,Yaya Kasse,Sita Millimono

doi:10.1080/07399332.2014.916293

Abstract

This article presents findings from a study on women's delivery care-seeking in two regions of Guinea. We explored exposure to interventions promoting birth preparedness and complication readiness among women with recent live births and stillbirths. Using multivariate regression models, we identified factors associated with women's knowledge and practices related to birth preparedness, as well as their use of health facilities during childbirth. We found that women's knowledge about preparations for any birth (normal or complicated) was positively associated with increased preparation for birth, which itself was associated with institutional delivery. Knowledge about complication readiness, obstetric risks, and danger signs was not associated with birth preparation or with institutional delivery. The study findings highlight the importance of focusing on preparation for all births—and not simply obstetric emergencies—in interventions aimed at increasing women's use of skilled maternity care.

Highlights

This article presents findings from a study on women’s delivery careseeking in two regions of Guinea
Using a subset of data from an evaluation study conducted in Guinea, we explore the influence of exposure to birth preparedness and complication readiness (BP/Complications Readiness (CR)) messages from two sources on women’s knowledge related to birth preparedness and complications readiness, their levels of preparation for childbirth, and, their care-seeking during delivery
Research and evaluations related to Birth Preparedness (BP)/CR interventions have yielded mixed evidence on the efficacy of such interventions; while some studies have indicated that BP/CR interventions are effective in increasing use of skilled delivery care (Magoma et al, 2013), others—and studies of interventions that focused primarily on complications readiness—have not shown any positive association with institutional delivery (Kumar et al, 2008; McPherson et al, 2006)

Summary

Introduction

This article presents findings from a study on women’s delivery careseeking in two regions of Guinea. Obstetric risks, and danger signs was not associated with birth preparation or with institutional delivery. The study findings highlight the importance of focusing on preparation for all births—and not obstetric emergencies—in interventions aimed at increasing women’s use of skilled maternity care. While there is consensus on skilled attendance during childbirth as an important intervention for improving maternal survival, rates of skilled attendance remain low, in sub-Saharan Africa, and evidence is lacking on effective interventions for increasing women’s access to and use of these services. Other researchers have explored both complication readiness and planning for normal delivery without making a clear distinction between the two (Agarwal, Sethi, Srivastava, Jha, & Baqui, 2010; Ekabua et al, 2011; Hailu, Gebremariam, Alemseged, & Deribe, 2011; Kabakyenga, Ostergren, Turyakira, & Pettersson, 2012; Kakaire, Kaye, & Osinde, 2011; Magoma et al, 2013; Mullany, Becker, & Hindin, 2007; Turan, Tesfagiorghis, & Polan, 2011), and several have included women’s use of antenatal care (ANC), the content of those consultations, or both, among measures of birth preparedness (Kakaire et al, 2011; Karkee, Lee, & Binns, 2013; McPherson et al, 2006)

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