Syrian women's preferences for birth attendant and birth place

Do breast cancer patients have a gender preference when choosing a breast surgeon?

Introduction

There is a paucity of data on breast cancer (BC) patients' gender preferences when it comes to choosing their surgeon, unlike in other specialties like gynaecology and obstetrics, where women tend to prefer a female physician. The aim of this trial was to examine if there are any gender preferences in women with BC at the time of choosing their breast surgeon.

Material and methods

A cross-sectional, observational and descriptive study with 528 patients, older than 18 years, at the Breast Department 'Servicio Oncológico Hospitalario del Instituto Venezolano de los Seguros Sociales', from January to June 2022. We applied an anonymous questionnaire to evaluate patients' gender preferences when it comes to choosing their breast surgeon.

Results

The average age of the patients was 56 ± 11 years. 89.4% did not have gender preferences, whereas 6.5% and 4.1% chose to be treated by female surgeons and male surgeons, respectively. The most important characteristics chosen by the patients when they decided to choose their breast surgeon were experience (75%), knowledge (54%) and hospital-based (41%).

Conclusion

Personal and professional skills are the most important factors when it comes to patients choosing their breast surgeon, gender does not have any impact on expertise or competence.

Factors Influencing Food Safety Education Practices among Obstetricians

Healthcare providers (HCPs) are responsible for educating pregnant women about food safety issues in to prevent infectious diseases; however, few HCPs provide their pregnant women with such information. This study aimed to identify food safety education practices, attitudes and barriers among obstetricians and determine the factors affecting education practices. In this cross-sectional study, 238 obstetricians completed a self-administered questionnaire. Medians with interquartile ranges, frequency, crosstabs test, Mann-Whitney U test, Kruska-Wallis H test, Dunn-Bonferroni post hoc method, and multiple regression were used for data analysis. The study found that obstetricians provide pregnant women with a low amount of food safety information (2.5 ± 0.42, and the top three barriers reported were lack of time (Mdn = 3, IQR = 1), lack of knowledge (Mdn = 3, IQR = 2), and heavy workload (Mdn = 3, IQR = 2). Furthermore, only a few obstetricians were interested in taking food safety education courses (30.2%) and exploring pregnant women's education needs (39.5%). Factors influencing education practices were total experience, lack of knowledge, and lack of time. Obstetricians should be more aware of the need to educate pregnant women about food safety issues. Understanding the influencing factors determined in this study will contribute to the development of an effective education plan to reinforce doctors' food safety education competency.

Preference of birth attendant gender and associated factors among antenatal care attendants at Debre Markos town public health facilities, Northwest Ethiopia: A cross-sectional study design 2021

OBJECTIVE

To assess the preference of birth attendant gender and associated factors among antenatal care attendants in Debre Markos town public health facilities, northwest Ethiopia, 2021.

METHOD

A facility-based cross-sectional study was conducted from 8 January 2021 to 28 February 2021 at Debre Markos town public health facilities. A total of 662 study participants were selected by systematic random sampling technique. Pretested interviewer-administered structured questionnaires were used for data collection. Data were entered using Epi Data version 3.1 and analyzed using SPSS version 25. Bivariable and multivariable logistic regression were applied to identify factors associated with birth attendant gender preference. Association was described by the "odd ratio" along with a 95% confidence interval. Finally, a P value < 0.05 in the adjusted analysis was used to declare a significant association.

RESULT

In this study, 644 women participated making a response rate of 97.3%. Of the total study participants, 108 (16.8%; 95% confidence interval: 13.8-19.4) preferred male birth attendants, while 232 (36%; 95% confidence interval: 32.5-39.8) preferred female birth attendants. Age (15-24) (adjusted odds ratio = 4.81, 95% confidence interval: 1.79, 12.94), no formal education (adjusted odds ratio = 2.94, 95% confidence interval: 1.32, 6.52), and primary education (adjusted odds ratio = 2.42, 95% confidence interval: 1.07, 5.47) were significantly associated with female birth attendant preference. A lack of formal education (adjusted odds ratio = 0.08; 95% confidence interval: 0.01, 0.68), secondary education (adjusted odds ratio = 0.34; 95% confidence interval: 0.16, 0.71), and history of assisted vaginal delivery (adjusted odds ratio = 3.72; 95% confidence interval: 1.40, 9.87) were significantly associated with a male birth attendant preference.

CONCLUSION

A female birth attendant is preferred by almost one-third of pregnant mothers, while one-sixth preferred a male. The clients who were younger in age and lower in educational status were more likely to prefer female birth attendants, whereas those who had a history of assisted vaginal delivery were more likely to prefer male birth attendants. To have a mother in the continuum of care, it is crucial to take her preferences into account when providing services.

Women's experiences throughout the birthing process in health facilities in Arab countries: a systematic review

BACKGROUND

Mistreatment of women during facility-based childbirth has become a significant public health issue globally and is gaining worldwide attention. This systematic review of quantitative studies aimed to estimate the prevalence of mistreatment women may experience throughout the birthing process in health facilities in Arab countries. The review also aimed to identify the types of mistreatment, terminology, tools, and methods used to address this topic.

METHODOLOGY

The search was conducted using three electronic databases: "PubMed," "Embase," and "CINAHL" in May 2020. Studies meeting the inclusion criteria were included and assessed for risk of bias. The analysis was conducted based on the evidence-based typology developed by Bohren et al. as a guide to try to estimate the prevalence of mistreatment.

RESULTS

Eleven studies out of 174 were included. The included studies belonged to only seven Arab countries out of 22 Arab countries. The mistreatment of women during childbirth is still new in the region. Searching within the included studies yielded diverse and indirect terms that were a proxy for the word mistreatment. These terms were not comprehensive to cover different aspects of the topic. The tools that were used to measure the terms widely varied.. Moreover, it was not possible to estimate the prevalence of mistreatment of women due to high heterogeneity among the 11 studies.

CONCLUSION

The topic of mistreatment of women in Arab countries was not adequately addressed in the studies included in this review. More research on this topic is recommended due to its importance in improving maternal health in the region. However, a standardized and comprehensive terminology for mistreatment of women, a standardized tool, and a standardized methodology are recommended to enable comparability between results and allow pooling to estimate the prevalence.

Childbirth Experiences and Delivery Care During Times of War: Testimonies of Syrian Women and Doctors

Background: Until the eruption of violence in 2011, Syria made good progress in improving maternal health indicators including reducing the maternal mortality ratio and increasing the level of skilled birth attendance. The war in Syria has been described as one of the worst humanitarian crises in recent times. Damascus Maternity Teaching Hospital is the largest maternity public hospital in the country that survived the war and continued to provide its services even during periods of pronounced instability. The main aim of this paper is to highlight the experience of childbirth and delivery care as described by women and doctors at times of severe violence affecting Damascus.

Methods: This paper is based on secondary analysis of qualitative data collected between 2012 and 2014 for a WHO-funded implementation research project introducing clinical audits for maternal near-misses. This analysis specifically looked at the effects of violence on the childbirth experience and delivery care from the perspective of both women and physicians. A total of 13 in-depth interviews with women who had recently delivered and survived a complication and 13 in-depth interviews with consultant obstetricians were reviewed and analyzed, in addition to three focus group discussions with 31 junior care providers.

Results: Three themes emerged concerning the experiences of women and doctors in these times of war. First, both women and doctors experienced difficulty reaching the hospital and accessing and providing the services, respectively; second, quality of care was challenged at that time as perceived by both women and doctors; and third, women and doctors expressed their psychological suffering in times of hardship and uncertainty and how this affected them.

Conclusions: Efforts to safeguard the safety of delivery and prevent maternal mortality in Syria continued despite very violent and stressful conditions. Both women and providers developed strategies to navigate the challenges posed by conflict to the provision of delivery care. Lessons learned from the experiences of both women and doctors should be considered in any plans to improve maternal healthcare in a country like Syria that remains committed to achieving the Sustainable Development Goals in 2030 in the aftermath of nearly 10 years of war.

A qualitative study exploring barriers to adequate uptake of antenatal care in pre-conflict Syria: low cost interventions are needed to address disparities in antenatal care

BACKGROUND

Syria has made progress in reducing maternal mortality and morbidity before the conflict in 2011. Despite the improvement in antenatal care (ANC) coverage and patterns of use, analyses of national surveys demonstrated wide regional variations in uptake, timing and number of visits even after controlling for women's socio-demographic characteristics. This study compares two governorates: Latakia, where uptake of ANC was high and Aleppo, where uptake of ANC was low to highlight the barriers to women's adequate uptake of ANC that existed in Syria pre-conflict.

METHODS

This qualitative study carried out 30 semi-structured interviews with (18-45-year-old) pregnant women from Aleppo and Latakia (recruited purposively from different types of health facilities in rural and urban areas), and 15 observation sessions at health facilities. Transcripts and fieldnotes were analyzed using the Framework Method with attention to the dimensions of availability, accessibility and acceptability of services.

RESULTS

Inadequate uptake of ANC in Aleppo included not attending ANC, seeking care with providers who are not trained to provide ANC or discontinuing care. Three themes explained the regional disparities in the uptake of ANC in Aleppo and Latakia: women's assessment of their health status and reasoning of causes of ill health in pregnancy; women's evaluation of the risks of seeking ANC; and women's appraisal of the value of different types of service providers. Poor experiences at public health facilities were reported by women in Aleppo but not by women in Latakia. Evaluations of ANC services were connected with the availability, accessibility (geographical and financial) and acceptability of ANC services, however, women's views were shaped by the knowledge and prevailing opinions in their families and community.

CONCLUSIONS

Findings are utilized to discuss low-cost interventions addressing the disparities in ANC uptake. Interventions should aim to enable vulnerable women to make informed decisions focusing on regions of low uptake. Women's groups that foster education and empowerment, which have been effective in other low resource settings, could be of value in Syria. Increased use of mobile phones and social media platforms suggests mobile health technologies (mHealth) may present efficient platforms to deliver these interventions.

Responding to health needs of women, children and adolescents within Syria during conflict: intervention coverage, challenges and adaptations

Background

Women and children suffer disproportionately in armed-conflicts. Since 2011, the protracted Syrian crisis has fragmented the pre-existing healthcare system. Despite the massive health needs of women and children, the delivery of key reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) interventions, and its underlying factors are not well-understood in Syria. Our objective was to document intervention coverage indicators and their implementation challenges inside Syria during conflict.

Methods

We conducted 1) a desk review to extract RMNCAH&N intervention coverage indicators inside Syria during the conflict; and 2) qualitative interviews with decision makers and health program implementers to explore reasons behind provision/non-provision of RMNCAH&N interventions, and the rationale informing decisions, priorities, collaborations and implementation. We attempt to validate findings by triangulating data from both sources.

Results

Key findings showed that humanitarian organisations operating in Syria adopted a complex multi-hub structure, and some resorted to remote management to improve accessibility to certain geographic areas. The emergency response prioritised trauma care and infectious disease control. Yet, with time, humanitarian organisations successfully advocated for prioritising maternal and child health and nutrition interventions given evident needs. The volatile security context had implications on populations' healthcare seeking behaviors, such as women reportedly preferring home births, or requesting Caesarean-sections to reduce insecurity risks. Additional findings were glaring data gaps and geographic variations in the availability of data on RMNCAH&N indicators. Adaptations of the humanitarian response included task-shifting to overcome shortage in skilled healthcare workers following their exodus, outreach activities to enhance access to RMNCAH&N services, and operating in 'underground' facilities to avoid risk of attacks.

Conclusion

The case of Syria provides a unique perspective on creative ways of managing the humanitarian response and delivering RMNCAH&N interventions, mainly in the multi-hub structure and use of remote management, despite encountered challenges. The scarcity of RMNCAH&N data is a tremendous challenge for both researchers and implementing agencies, as it limits accountability and monitoring, thus hindering the evaluation of delivered interventions.

Is the place of birth related to the mother's satisfaction with childbirth? A cross-sectional study in a rural district of the Lao People's Democratic Republic (Lao PDR)

Background

The place of birth has been rapidly changing from home to health facility in Lao People’s Democratic Republic (Lao PDR) following the strategy to improve the maternal and neonatal mortality. This change in the place of birth might affect the mother’s satisfaction with childbirth. The objective of this study was to assess whether the place of birth is related to the mother’s satisfaction with childbirth in a rural district of the Lao PDR.

Methods

A community-based survey was implemented in 21 randomly selected hamlets in Xepon district, Savannakhet province, between February and March, 2016. Questionnaire-based interviews were conducted with mothers who experienced a normal vaginal birth in the past 2 years. Satisfaction with childbirth was measured by the Satisfaction with Childbirth Experience Questionnaire. Using the median, the outcome variable was dichotomized into “high satisfaction group” and “low satisfaction group”. Logistic regression was performed to assess the association between place of birth and satisfaction with childbirth. Three models were examined: In Model 1, only the predictor of interest (i.e., place of birth) was included. In Model 2, the predictor of interest and the obstetrical predictors were included. In Model 3, in addition to these predictors, socio-demographic and economic predictors were included. A mixed-effects model was used to account for the hierarchical structure.

Results

Among the 226 mothers who were included in data analysis, 60.2% gave birth at the health facility and the remaining 39.8% gave birth at home. Logistic regression analysis showed that the mothers who gave birth at the health facility were significantly more likely to have a higher level of satisfaction compared to the mothers who gave birth at home (crude odds ratio: 5.44, 95% confidence interval: 3.03 to 9.75). This association remained even after adjusting for other predictors (adjusted odds ratio: 6.05, 95% confidence interval: 2.81 to 13.03).

Conclusion

Facility-based birth was significantly associated with a higher level of satisfaction with childbirth among the mothers in the study district where maternal and neonatal mortalities are relatively high. The findings of the present study support the promotion of facility-based birth in a rural district of the Lao PDR.

Gender of Provider-Barrier to Immigrant Women's Obstetrical Care: A Narrative Review

OBJECTIVE

To explore the preference for female obstetrician/gynaecologists among immigrant women, and providers' understandings of these preferences, to identify challenges and potential solutions.

METHODS

Five databases (Medline, Embase, CINAHL, Global Health, and Scopus) were searched using combinations of search terms related to immigrant, refugee, or Muslim women and obstetrics or gynaecological provider gender preference.

STUDY SELECTION

Peer reviewed, English-language articles were included if they discussed either patient or provider perspectives of women's preference for female obstetrics or gynaecological care provider among immigrant women in Western and non-western settings. After screening, 54 met inclusion criteria and were reviewed.

DATA EXTRACTION

Studies were divided first into those specifically focusing on gender of provider, and those in which it was one variable addressed. Each category was then divided into those describing immigrant women, and those conducted in a non-Western settings. The research question, study population, methods, results, and reasons given for preferences in each article were then examined and recorded.

CONCLUSION

Preference for female obstetricians/gynaecologists was demonstrated. Although many will accept a male provider, psychological stress, delays, or avoidance in seeking care may result. Providers' views were captured in only eight articles, with conflicting perspectives on responding to preferences and the health system impact.

Opting for home birth in rural Bangladesh: An assessment of the current status and reasons

BACKGROUND

In Bangladesh, over half of women give birth at home, generally without the support of a skilled birth attendant. In this article, we examined the decision-making around birthplace and explored the reported reasons of preferring home birth over facility birth in a rural district of Bangladesh.

METHODS

A cross-sectional household survey with 1367 women was conducted in Brahmanbaria district. Choice of birthplace and actual place of birth were the main outcomes of interest. Associations between the outcomes of interest and background characteristics were analyzed through binary logistic regression. Effects of the covariates and confounders were adjusted through multiple logistic regression.

RESULTS

Sixty-four percent of women planned to give birth at home, and 62% gave birth at home. Planning to give birth at home was significantly associated with eventually giving birth at home (AOR [CI]: 4.93 [3.79-6.43]). Multiparous women and women from larger households were significantly more likely to give birth at home, whereas more educated and wealthier women and those attending antenatal care were significantly less likely to give birth at home. The main reported reasons for home birth were perceived lack of importance of facility birth, financial reasons, fear of cesarean section, and not being permitted by a husband of other family member to seek facility birth.

CONCLUSIONS

Home is the preferred birthplace and main actual place of birth in rural Bangladesh. The maternal health program of Bangladesh should look critically at the preferences of women and reasons for those preferences for further promotion of skilled attendance at birth in rural settings.

Perspectives of displaced Syrian women and service providers on fertility behaviour and available services in West Bekaa, Lebanon

Prior to the conflict, Syria had relatively high fertility rates. In 2010, it had the sixth highest total fertility rate in the Arab World, but it witnessed a fertility decline before the conflict in 2011. Displacement during conflict influences fertility behaviour, and meeting the contraceptive needs of displaced populations is complex. This study explored the perspectives of women and service providers about fertility behaviour of and service provision to Syrian refugee women in Bekaa, Lebanon. We used qualitative methodology to conduct 12 focus group discussions with Syrian refugee women grouped in different age categories and 13 in-depth interviews with care providers from the same region. Our findings indicate that the displacement of Syrians to Lebanon had implications on the fertility behaviour of the participants. Women brought their beliefs about preferred family size and norms about decision-making into an environment where they were exposed to both aid and hardship. The unaffordability of contraceptives in the Lebanese privatised health system compared to their free provision in Syria limited access to family planning services. Efforts are needed to maintain health resources and monitor health needs of the refugee population in order to improve access and use of services.

Health research in a turbulent region: the Reproductive Health Working Group

The Reproductive Health Working Group (RHWG) was established in 1988 in Cairo to advance research in the Arab countries and Turkey on the health of women, broadly defined. The paper considers the ways in which the group contributed to global health conversations through three examples of interdisciplinary research that, in privileging local contexts, modified or even challenged prevailing approaches to health and often raised entirely new issues for consideration. The three examples cited in the paper are: (i) the network's early research on reproductive morbidity; (ii) a broad set of ongoing studies on childbirth/maternal health; and (iii) emerging research on health and conflict. The paper discusses how the RHWG has strengthened research capability in the region, and explores the reasons for the longevity of this research network.

Maternal Health Care Utilization Among Syrian Refugees in Lebanon and Jordan

Purpose The influx of Syrian refugees into Jordan and Lebanon over the last 5 years presents an immense burden to national health systems. This study was undertaken to assess utilization of maternal health services among Syrian refugees in both countries. Description A cross-sectional survey of Syrian refugees living in urban and rural (non-camp) settings was conducted using a two-stage cluster survey design with probability proportional to size sampling in 2014-2015. Eighty-six percent of surveyed households in Lebanon and 88% of surveyed households in Jordan included women with a live birth in the last year. Information from women in this sub-set of households was analyzed to understand antenatal and intrapartum health service utilization. Assessment A majority of respondents reported seeking antenatal care, 82% and 89% in Jordan and Lebanon, respectively. Women had an average of at least six antenatal care visits. Nearly all births (98% in Jordan and 94% in Lebanon) took place in a health facility. Cesarean rates were similar in both countries; approximately one-third of all births were cesarean deliveries. A substantial proportion of women incurred costs for intrapartum care; 33% of Syrian women in Jordan and 94% of Syrian women in Lebanon reported paying out of pocket for their deliveries. The proportion of women incurring costs for intrapartum care was higher in Jordan both countries for women with cesarean deliveries compared to those with vaginal deliveries; however, this difference was not statistically significant in either country (Jordan p-value = 0.203; Lebanon p-value = 0.099). Conclusion Syrian refugees living in Jordan and Lebanon had similar levels of utilization of maternal health services, despite different health systems and humanitarian assistance provisions. As expected, a substantial proportion of households incurred out-of-pocket costs for essential maternal and newborn health services, making cost a major factor in care-seeking decisions and locations. As health financing policies shift to account for the continued burden of refugee hosting on the health system, sustained attention to the availability and quality of essential maternal and newborn health services is needed to protect both refugee and host populations women's rights to health and health care during pregnancy, childbirth, and the postpartum period.

Pregnant women's preference and factors associated with institutional delivery service utilization in Debra Markos Town, North West Ethiopia: a community based follow up study

Background

Majority of deaths from obstetric complications are preventable. But every pregnant woman face risks which may not always be detected through the risk assessment approach during antenatal care (ANC). Therefore, the presence of a skilled birth attendant in every delivery is the most critical intervention in reducing maternal mortality and morbidity. In Ethiopia the proportion of births attended by skilled personnel, is very low, even for women who have access to the services.

Methods

A community-based follow up study was conducted from January 17, 2012 to July 30, 2012, among 2^nd and 3^rd trimester’s pregnant women in Debre-Markos town, east Gojam Zone, Amhara Region, North West Ethiopia. Simple random sampling technique was used to get a total sample size of 422 participants.

Results

A total of 393 pregnant women were included in the study. The study revealed that 292(74.3%) of the pregnant women planned to deliver in a health institution. Of these 292 pregnant women 234 (80.14%) actually delivered in a health facility.

Age range from 15–19 year (AOR = 4.83, 95% CI = 1.562-12.641), college and above education of the pregnant women (AOR = 12.508, 95% CI = 1.082-14.557), ANC visit during the current pregnancy (AOR = 1.975, 95% CI = 1.021-3.392),perceived susceptibility and severity of pregnancy and delivery complication (AOR = 3.208, 95% CI = 1.262-8.155) and intention (preference) of pregnant women for place of delivery (AOR = 7.032, 95% CI = 3.045-10.234) are predictors of institutional delivery service utilization.

Conclusions

Preference for institutional delivery is low in the study area. Sociodemographic factors, perception about delivery complication, ANC follow up and their intentions for institutional delivery are among important predictors of institutional delivery.

U.S. Nulliparas' Reasons for Expected Provider Type and Childbirth Setting

The objective of this study was to describe nulliparas' reasons for the type of provider (i.e., midwife, physician) and childbirth setting (i.e., home, hospital, hospital-based birth center) that respondents expected for their births. Data were collected via a cross-sectional, descriptive, self-administered, Web-based survey including both close- and open-ended questions and were analyzed using conventional content analysis. Respondents were 220 nulliparous women aged 18-40 years, living in the United States, and pregnant at 20 or fewer weeks' gestation. Women's reasons were categorized broadly as relating to provider/setting attributes, relationship with provider/setting, normative choices, respondent attributes, and practical considerations. Respondents' reasons highlight misconceptions about childbirth care options, especially regarding midwifery and nonhospital settings, which may be addressed by childbirth education.

Cesarean sections among Syrian refugees in Lebanon from december 2012/january 2013 to june 2013: probable causes and recommendations

INTRODUCTION

There are nearly 3 million Syrian refugees, with more than 1 million in Lebanon. We combined quantitative and qualitative methods to determine cesarean section (CS) rates among Syrian refugees accessing care through United Nations High Commissioner for Refugees (UNHCR)-contracted hospitals in Lebanon and possible driving factors.

METHODS

We analyzed hospital admission data from UNHCR's main partners from December 2012/January 1, 2013, to June 30, 2013. We collected qualitative data in a subset of hospitals through semi-structured informant interviews.

RESULTS

Deliveries accounted for almost 50 percent of hospitalizations. The average CS rate was 35 percent of 6,366 deliveries. Women expressed strong preference for female providers. Clinicians observed that refugees had high incidence of birth and health complications diagnosed at delivery time that often required emergent CS.

DISCUSSION

CS rates are high among Syrian refugee women in Lebanon. Limited access and utilization of antenatal care, privatized health care, and male obstetrical providers may be important drivers that need to be addressed.

Assessment on the knowledge and reported practices of women on maternal and child health in rural Sierra Leone: a cross-sectional survey

BACKGROUND

Globally, Sierra Leone is ranked among the countries with the worst maternal and child health indicators. The mortality of women and children is significantly higher compared with other developing countries. The death of women and children can be prevented by simple cost-effective community-based interventions. The aim of this present study was to learn the knowledge levels of women on maternal and child health, and treatment-seeking and preventive behaviours in rural Sierra Leone and provide appropriate suggestions for policy makers. Moreover, the study also aimed to evaluate the effect of a husband's involvement on health knowledge and practices of women in rural Sierra Leone.

METHODS

Women with at least a child of five years or below were interviewed in their households through a structured questionnaire. Characteristics of the households and of the respondents were collected and the number of correct answers given to the health knowledge and practice questions and their percentage distributions were tabulated and an overall health knowledge score was calculated.

RESULTS

The mean score of the derived overall health-related knowledge was 61.6% (maximum of 91% and a minimum of 18%) with a standard deviation of 14.7% and a median of 63.3%. Multivariable regression analyses showed education and number of pregnancies are associated with knowledge score, with significantly improved health knowledge scores amongst those who accessed higher education. There were some inappropriate practices in hygiene and sanitation. However, vaccination coverage was high with almost 100% coverage for BCG.

CONCLUSIONS

Based on the findings of this study, women's knowledge on maternal and child health care are inadequate in rural Sierra Leone. Health promotion activities focusing on prevention of diarrhoea, malaria and pneumonia, improvement in health-related knowledge on pregnancy, delivery, neonatal care and environmental sanitation would be invaluable.

Perceptions of barriers to paternal presence and contribution during childbirth: an exploratory study from Syria

BACKGROUND

The barriers that face fathers during childbirth are an understudied phenomenon. The objective of our study was to explore Syrian parents' perceptions of barriers to paternal presence and contribution during childbirth.

METHODS

A descriptive phenomenological qualitative approach based on Colaizzi's method was used with a purposive sample of 23 mothers and 14 fathers recruited from a major public maternity hospital in Syria.

RESULTS

In our study, four themes on barriers to paternal presence and contribution during childbirth were found: 1) sociocultural influences and rigidity; 2) being unprepared; 3) unsupportive policies and attitudes; and 4) unfavorable reactions and circumstances.

CONCLUSIONS

Common and current sociocultural norms in Syria do not encourage fathers to be present or contribute during childbirth. Therefore, establishing culturally sensitive supportive policies and practices is a vital step toward overcoming these barriers.

The roles of the father during childbirth: the lived experiences of Arab Syrian parents

In our study, we explored the roles of a father during childbirth as perceived by Arab Syrian parents. A descriptive phenomenological approach was used to analyze transcripts from interviews and focus groups. Four themes emerged: (a) psychological and spiritual support, (b) being present and concerned, (c) being ready and alert, and (d) fulfilling social obligations. Most women preferred to have their mothers with them during childbirth instead of their husbands. Current health policies do not encourage fathers to play active roles during childbirth and need revision, within culturally acceptable parameters and norms, to meet the health needs of clients.

Unpredicted gender preference of obstetricians and gynecologists by Muslim Israeli-Arab women

OBJECTIVES

To investigate the gender preference of Muslim Israeli-Arab women regarding obstetricians/gynecologists, and identify other features that affect their choice.

METHODS

The study included 167 responders to an anonymous questionnaire.

RESULTS

Around one-half of the responders had no gender preference regarding family physicians, but most (76.6%) preferred a female gynecologist. Likewise, most responders preferred pelvic examinations (85.6%) and pregnancy follow-up (77.8%) by female gynecologists. Additionally, 61.7% preferred consulting female physicians for major obstetrical and gynecological (OB/GYN) problems. The reasons for female preference were embarrassment (67.7%), feeling comfortable with female gynecologists (80.8%) and the notion that female gynecologists are more gentle (68.3%). The three most important factors which affected actual selection, however, were experience (83.8%), knowledge (70.1%) and ability (50.3%), rather than physician gender (29.3%). Multivariate analysis revealed that other qualities and importance of background variables of the gynecologist were independent predictors of gender preference.

CONCLUSIONS

Although Muslim Arab-Israeli women express gender bias regarding their preference for gynecologists/obstetricians, personal and professional skills are considered to be more important factors when it comes to actually making a choice.

PRACTICE IMPLICATION

We suggest that the ideal obstetrician/gynecologist for these women would be female, though skilled, knowledgeable, and experienced male would be appropriate.

Home birth in women who have given birth at least once in a health facility: contributory factors in a developing country

OBJECTIVE

To study the link between patients' satisfaction about received services in health facilities and the choice of future delivery place of women who had delivered at least once in a facility.

DESIGN

Cross-sectional study.

SETTING

Health district Gossas in Senegal.

SAMPLE

Three hundred and seventy-three women who gave birth in the last 12 months.

METHODS

Data were collected using a questionnaire during an interview. Logistic regression was used to explore the determinants of childbirth at home using the Andersen behavioral model.

MAIN OUTCOME MEASURES

Place of delivery and satisfaction at reception and conduct of delivery.

RESULTS

The average age was 28±6years. Among the women interviewed, 97% were married, 53% being in a polygamous system, and 18% were educated. Forty-seven per cent of them were satisfied with the quality of the last delivery made within a health facility. The prevalence of home birth was 22%. Home births were more frequent among women in a polygamous marriage [odds ratio (OR) 1.85; 95% confidence interval (CI) 1.01-3.14], with no means of transportation (OR 1.68; 95% CI 1.02-3.95) and who lived more than 5km from a health facility (OR 2.24; 95% CI 1.21-4.15). Poor quality of delivery in a health facility (OR 2.52; 95% CI 1.36-4.65) or a delivery done by a male provider (OR 3.90; 95% CI 2.30-6.65) were also risk factors for the choice of home delivery.

CONCLUSIONS

Particular emphasis should be placed on training healthcare providers to improve the quality of service provided to patients in health facilities.

Knowledge and reported practices of men and women on maternal and child health in rural Guinea Bissau: a cross sectional survey

Background

Participatory health education interventions and/or community-based primary health care in remote regions can improve child survival. The most recent data from Guinea Bissau shows that the country ranks 5^th from bottom globally with an under-five mortality rate of 198 per 1000 live births in 2007. EPICS (Enabling Parents to Increase Child Survival) is a cluster randomised trial, which is currently running in rural areas of southern Guinea Bissau. It aims to evaluate whether an intervention package can generate a rapid and cost-effective reduction in under-five child mortality. The purpose of the study described here was to understand levels of knowledge on child health and treatment-seeking and preventative behaviours in southern Guinea Bissau in order to develop an effective health education component for the EPICS trial. The study also aimed to assess the effect of gender and ethnicity on knowledge and behaviour.

Methods

Women and men were interviewed in their households using a structured questionnaire. Characteristics of the households and of the interviewed women and men were tabulated. The number of correct answers given to the health knowledge and practice questions and their percentage distribution were tabulated by items and by gender. An overall health knowledge score was derived.

Results

There are low levels of appropriate knowledge on child health, some inappropriate practices and generally low vaccination coverage. Health knowledge scores improve significantly amongst those who have accessed higher education. Differences in health knowledge between women and men become insignificant once age and education are accounted for.

Conclusions

Health education activities should be an integral part of a package to improve child survival in rural Guinea Bissau. These activities should focus on diarrhoea, malaria, pneumonia, pregnancy, delivery, neonatal care and vaccination coverage, as these are areas where knowledge and practices were found to be inadequate in this study. Men as well as women should be involved in these activities. Prior to developing health education interventions in similar settings, studies to assess areas to be targeted should be conducted.

Hospital-based caesarean section in the Arab region: an overview

This article provides an overview of hospital-based rates of caesarean delivery in 18 Arab countries and the association between these rates and selected demographic and socioeconomic characteristics. Data on caesarean section were based on 2 of the most recent national hospital-based surveys in each country and on published studies based on hospital samples. High levels of caesarean delivery were found in Egypt (26% in 2003), followed by Sudan (20% in 1993). Six countries and the West Bank area of Palestine had rates >15% and 11 countries and Gaza had rates between 5% and 15%. The findings indicate an increasing trend of caesarean section delivery in the region. Policies aiming at reducing surgical deliveries should seek to identify and address these risk factors.

Writing place: a comparison of nursing research and health geography

The concept of 'place', and general references to 'geographies of ...' are making gradual incursions into nursing literature. Although the idea of place in nursing is not new, this recent spatial turn seems to be influenced by the increasing profile of the discipline of health geography, and the broadening of its scope to incorporate smaller and more intimate spatial scales. A wider emphasis within the social sciences on place from a social and cultural perspective, and a wider turn to 'place' across disciplines are probably equally important factors. This trend is raising some interesting questions for nurses, but at the same time contributes some confusion with regard to imputed meanings of 'place'. While it is clear that most nurse clinicians and researchers certainly understand that place of care matters to their practices and patients, many diverse uses of 'place' are found within nursing literature, and contemporary understandings of the term 'place' within nursing are not immediately clear. It is in this context that this article plans to advance the discussion of place. More specifically, the aims of this paper are threefold: to critique 'place' as it appears in nursing literature, to explore the use of 'place' within health geography, whence notions of place and 'geographies of' have originated and, finally, to compare and contrast the use of 'place' in both disciplines. This critique intends to address a deficit in the literature, in this era of growing spatialization in nursing research. The specific questions of interest here are: 'what is "place" in nursing?' and 'how do concepts of place in nursing compare to concepts of place in health geography?'

The limitations on choice: Palestinian women's childbirth location, dissatisfaction with the place of birth and determinants

BACKGROUND

Analysing the Palestinian Central Bureau of Statistics (PCBS) Demographic and Health Survey 2004 (DHS-2004) data, this article focuses on the question of where women living in the Occupied Palestinian Territory give birth, and whether it was the preferred/place of choice for delivery. We further identify some of the determinants of women's dissatisfaction with childbirth location.

METHODS

A total of 2158 women residing in the West Bank and Gaza Strip were included in this study. Regression analysis established the association between dissatisfaction with the place of birth and selected determinants.

RESULTS

A total of 3.5% of women delivered at home, with the rest in assisted facilities. Overall, 20.5% of women reported that their childbirth location was not the preferred place of delivery. Women who delivered at home; in governmental facilities; in regions other than the central West Bank; who had sudden delivery or did not reach their preferred childbirth location because of closures and siege; because of costs/the availability of insurance; or because there were no other locations available, were significantly more likely to be dissatisfied with their childbirth location compared to those who birthed in private facilities, the central West Bank, and in locations with better and more available services.

CONCLUSION

The findings demonstrate that Palestinian women's choice of a place of birth is constrained and modified by the availability, affordability, and limited access to services induced by continuing closures and siege. These findings need to be taken into consideration when planning for maternity services in the Occupied Palestinian Territory.

Syrian Women's Perceptions and Experiences of Ultrasound Screening in Pregnancy: Implications for Antenatal Policy

Ultrasound scanning is firmly embedded in antenatal maternity care around the world. This paper reports on a qualitative study carried out in 2003 of 30 Syrian women's perceptions and experiences of routine ultrasound in pregnancy. It was part of a larger study of the experiences of pregnancy and childbirth of 500 women from Damascus and its suburbs who had recently given birth to healthy newborns. The women had had multiple scans during pregnancy and accepted its use uncritically nearly all the time. The scans gave them reassurance that the baby was healthy, the pregnancy was progressing well and allowed them to learn the sex of the baby. The women also reacted positively to the antenatal educational messages that were conveyed using scans. However, we found the excessive use of this technology worrying. We believe private doctors, who attend 80% of pregnant women, use ultrasound primarily to attract women to their clinics and increase their income. We recommend that maternity care in Syria should be better regulated; that women and their doctors should be made aware of the essential components of antenatal care; that notional guidelines for antenatol care should be developed and that Syrian women should be empowered to ask questions about pregnancy and childbirth and the care they receive.