Abstract
Despite efforts to improve access to and quality of care for newborns, the first month after birth remains the most dangerous period of life. Given high neonatal mortality in low-income countries, saving newborn lives is a key priority for global and national health policy agendas. However, little is known about how these policies resonate with local understandings, experiences and household priorities. In this qualitative study we examined families' decision making and health-care-seeking in Butajira, Ethiopia. Data were collected through observation in hospital, in-depth interviews (41), and focus group discussions (7) with family members, health-care workers, and community members (October–November 2015). Transcripts and field notes were analyzed inductively using qualitative content analysis. Findings indicate that newborn health was not always the family's priority. Local perceptions of newborns as not yet useful members of the household alongside costly health-care services delayed decision making and care-seeking. While sickness was recognized as dangerous for the ill newborn, seeking health-care could be harmful for the economic survival of the family. In a resource-constrained setting, families' focused on productive assets in order to minimize long-term risks, and waited before seeking newborn health-care services. Until the baby had survived the first vulnerable weeks and months of life, the unknown newborn was not yet seen as a social person by the community. Personhood evolved progressively as the baby became a part of the family. A newborn death was surrounded by silence, and families received minimal support from traditional financial associations, iddirs. Decisions regarding health-care were contingent upon families' understandings of newborns and their resource-constrained circumstances. Improving newborn health involves recognizing why families choose to (not) seek health-care, and their actual opportunities and constraints in making such decisions. The everyday realities of vulnerable newborns must be at the center of global and national policy discussions and local implementation.
Highlights
While most newborn deaths are avoidable, neonatal mortality remains high (Bhutta et al, 2014; Wang et al, 2016)
Newborn health became a central part of the global health agenda during the Millennium Development Goal (MDG) era, where new policies, programs, and guidelines on newborn health-care were developed
These factors mutually reinforced an ambiguous attitude towards the ill newborn, which in turn affected health-care-seeking
Summary
While most newborn deaths are avoidable, neonatal mortality remains high (Bhutta et al, 2014; Wang et al, 2016). The medical literature has highlighted that 71% of newborn deaths could be averted with increased access to quality care (Bhutta et al, 2014). Studies show large variations (10%–100%) as to whether caregivers seek treatment when children are ill (Herbert et al, 2012; Noordam et al, 2015). This may be explained by lack of knowledge about danger signs, disrespectful and low quality care, lack of available and affordable health services (Bhutta et al, 2014; Callaghan-Koru et al, 2013; Sacks, 2017; Shaw et al, 2016), or by structural barriers, such as poverty, rural location, lack of education, and gender roles (Central Statistical Agency [Ethiopia] and ICF, 2016; Richards et al, 2013)
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