Abstract
The Sustainable Development Goal Three has prioritised reducing maternal, under-5 and neonatal mortalities as core global health policy objectives. The place, where expectant mothers choose to deliver their babies has a direct effect on maternal health outcomes. In sub-Saharan Africa, existing literature has shown that some women attend antenatal care during pregnancy but choose to deliver their babies at home. Using the Andersen and Newman Behavioural Model, this study explored the institutional and socio-cultural factors motivating women to deliver at home after attending antenatal care. A qualitative, exploratory, cross-sectional design was deployed. Data were collected from a purposive sample of 23 women, who attended antenatal care during pregnancy but delivered their babies at home, 10 health workers and 17 other community-level stakeholders. The data were collected through semi-structured interviews, which were audio-recorded, transcribed and thematically analysed. In line with the Andersen and Newman Model, the study discovered that traditional and religious belief systems about marital fidelity and the role of the gods in childbirth, myths about consequences of facility-based delivery, illiteracy, and weak women's autonomy in healthcare decision-making, predisposed women to home delivery. Home delivery was also enabled by inadequate midwives at health facilities, the unfriendly attitude of health workers, hidden charges for facility-based delivery, and long distances to healthcare facilities. The fear of caesarean section, also created the need for women who attended antenatal care to deliver at home. The study has established that socio-cultural and institutional level factors influenced women's decisions to deliver at home. We recommend a general improvement in the service delivery capacity of health facilities, and the implementation of collaborative educational and women empowerment programmes by stakeholders, to strengthen women's autonomy and reshape existing traditional and religious beliefs facilitating home delivery.
Highlights
The World Health Organization (WHO) [1] estimated that about 295 000 women died due to causes related to pregnancy and childbirth in 2017
Home delivery was enabled by inadequate midwives at health facilities, the unfriendly attitude of health workers, hidden charges for facility-based delivery, and long distances to healthcare facilities
Our study revealed that traditional practices such as the need for a woman to prove her faithfulness to her husband predisposed women to deliver at home
Summary
The World Health Organization (WHO) [1] estimated that about 295 000 women died due to causes related to pregnancy and childbirth in 2017. Two reasons account for this state of affairs—low skilled delivery and poor quality of antenatal care [2] For these reasons, the Sustainable Development Goal (SDG) Three has prioritised reducing maternal, under-5 and neonatal mortalities as core global health policy objectives [3]. Place of delivery— the place where expectant mothers choose to deliver their babies has a direct effect on maternal health outcomes. Scholarship from sub-Saharan Africa, reported that 60% of mothers do not have a skilled birth attendant (SBA) present during childbirth, and that out of 95% of pregnant women who attended antenatal care (ANC) in health facilities, almost half (47%) of them delivered at home [4]. In sub-Saharan Africa, existing literature has shown that some women attend antenatal care during pregnancy but choose to deliver their babies at home. Using the Andersen and Newman Behavioural Model, this study explored the institutional and socio-cultural factors motivating women to deliver at home after attending antenatal care
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