Abstract
BackgroundDespite expanding the number of health facilities, Ethiopia has still the highest home delivery services utilization. Health care service utilization varies between regions within the country. This study explored the socio-cultural factors influencing health facility delivery in a pastoralist region of Afar, Ethiopia.MethodsAn explorative qualitative study was conducted in October–December 2015. A total of 18 focus group discussions were conducted separately with mothers, male tribal leaders and religious leaders. In addition, 24 key informant interviews were conducted with Women’s Affairs Bureau and district health office experts and traditional birth attendants and all were selected purposively. Data were coded and categorized using open code software and analyzed based on a thematic approach.ResultsThe social factors that affect the choice of delivery place include workload, lack of independence and decision-making power of women, and lack of substitute for childcare and household chores during pregnancy and childbirth. The cultural and spiritual factors include assuming delivery as natural process ought to happen at home, trust in traditional birth attendants, traditional practices during and after delivery and faithful to religion practice, besides, denial by health facilities to benign traditional and spiritual practices such as prayers and traditional food preparations to be performed over there.ConclusionSocio-cultural factors are far more than access to health centers as barriers to the utilization of health facilities for child birth. The provision of a maternity waiting home around the health facilities can alleviate some of these socio-cultural barriers.
Highlights
Despite expanding the number of health facilities, Ethiopia has still the highest home delivery services utilization
Study area The study was conducted in six districts of Afar regional state of Ethiopia where more than 75% population is living a pastoralist lifestyle
The traditional birth attendants (TBAs) reported at least 6 years of experience in providing delivery services in the area, all were unable to read and write and Muslim by faith. (Table 1)
Summary
Despite expanding the number of health facilities, Ethiopia has still the highest home delivery services utilization. All these deaths occur in lowincome settings though most of the deaths are preventable [3, 5] The extent of these maternal deaths due to childbirth-related complications varies among different women population in sub-Saharan Africa, predominantly by low-income population [3, 5]. It indicates the need of developing context-specific strategies to reduce maternal mortality to less than 70 deaths per 100,000 live births by 2030 in all countries and geographic localities [6]. Despite the increasing number of health facilities, the utilization of health facilities for delivery is very low in Ethiopia, with considerable variation between the regional states [7, 10]
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