A qualitative study on rural women's experiences relating to the utilisation of birth care provided by skilled birth attendants in the rural areas of Bongo District in the Upper East Region of Ghana

Association between decision-making during pregnancy and woman-centred care among Tanzanian pregnant women: A cross-sectional survey

BACKGROUND

Many women in Tanzania lack autonomy in decision-making for their pregnancy and childbirth. Woman-centred care (WCC) seeks to provide each woman with the appropriate information that promotes participation and highlights their informed decision-making. Thus, decision-making has been proposed as an essential determinant of WCC. This study aimed to assess the association between decision-making and WCC among Tanzanian pregnant women.

METHODS

We conducted a cross-sectional study among 710 pregnant women in Tanzania. The 23-item Woman-Centred Care English version questionnaire was used to assess how women perceived the care provided by midwives. Participants were categorized into two decision-making groups: decision-making for the birthing place by pregnant women themselves and by others. The pre-defined cut-off point of the top 20 percentile was used to indicate a high level of WCC. Binary logistic regression models were used to determine the association between decision-making and WCC.

RESULTS

The median score (interquartile range) of WCC was 97 (92-103) points when decisions were made by pregnant women, compared to 92 (88-96) points when decisions were made by others (p<0.001). There was a significant association between decision-maker and WCC in both unadjusted (p<0.001) and multivariable-adjusted (p=0.006) analyses. The unadjusted odds were approximately 5 times higher in the pregnant women decision-making group (OR: 4.80, 95% CI: 2.74-8.43) and 3 times higher (OR:2.90, 95% CI: 1.36-6.07) after the adjustment for covariates. We observed no significant interaction between decision-making and parity on the level of WCC (p for interaction=0.52).

CONCLUSION

Pregnant women who made decisions for the birthing place had a higher likelihood of having a high level of WCC compared with their counterparts. Our findings suggest that women should be empowered to be involved in decision-making to increase their satisfaction with the care provided by healthcare providers and foster a positive childbirth experience.

The Disposal of Placenta among Indigenous Groups Globally: An Integrative Literature Review

Introduction

The placenta, or afterbirth, plays a vital role in supplying nutrients and oxygen via the umbilical cord. Western medicine sees the placenta as a medical waste and discards it after delivery. Meanwhile, indigenous groups observe rituals or ceremonies prior to their disposal since it bears sacred importance.

Aim

The aim of the literature review is to review the current literature on indigenous methods of disposing placenta.

Methods

Through the EBSCOhost search engine, the authors had access to the following databases: CINAHL; MEDLINE; E-Journals; Health Sources: Nursing/Academic Edition; Scopus; and African Journals Online. A manual search of the grey literature through Google Scholar and Google Search engines, as well as citation searching using reference lists, was also used. The following keyword searches came up: placental disposal, placental waste, placental release, indigenous placental disposal, traditional placental disposal, cultural placenta, and placental rituals. The authors followed the inclusion criteria of qualitative, quantitative, or mixed research articles or reports from experts and different organisations published between 2013 and 2022 in English. Findings. The following three themes with subthemes emerged in the context of this review paper: (1) placental consumption (increases milk production, prevents postpartum depression, and prevents postpartum bleeding); (2) placental burial (burial site determines the child's fate, protection of the child, and fertility); and 3). artifacts (memorabilia).

Conclusion

Indigenous placental disposal methods have a significant value to Indigenous women globally. The rituals performed have a special meaning attached to them. It is important for Western medicine to respect and support indigenous placental disposal methods and ensure safe handling from the healthcare facilities to their homes.

Pregnant Women's Views Regarding Maternity Facility-Based Delivery at Primary Health Care Facilities in the Province of KwaZulu-Natal in South Africa

For women giving birth, every moment of delay in receiving skilled care significantly increases the risks of stillbirth, neonatal and maternal death. More than half of all births in developing countries, including South Africa, take place outside a health facility and without skilled birth attendants. Therefore, this has made it difficult to achieve the Sustainable Development Goals of global reduction in maternal mortality, which is a key health challenge globally, especially in developing countries and sub-Saharan Africa in particular. The study aimed to explore and describe the views of pregnant women regarding facility-based delivery. Focus group discussions were used to gather information from pregnant women. Information was collected from six groups of pregnant women who had delivered babies at the primary health care facilities in the past 5 years. Results showed several factors associated with the failure to use institutional delivery services, such as the lengthy distance from the health care facility, lack of transport, lack of transport fare, shortages of skilled staff, failure to disclose pregnancy, cultural and religious beliefs, and staff attitudes.

Exploring Women's Reasons for Choosing Home Birth with the Help of Their Untrained Family Members: A Qualitative Research

Background

Home births with the help of untrained family members continue to be women's preference in Indonesia. However, the practice has received very little attention. The purpose of this study was to explore women's reasons for choosing home births with the help of their untrained family members.

Methods

This study used an exploratory-descriptive qualitative research approach and was conducted from April 2020 to March 2021 in Riau Province, Indonesia. A total of 22 respondents determined by data saturation was recruited using purposive and snowball samplings. The respondents consisted of 12 women who had at least one planned home birth with the help of their untrained family members, and 10 untrained relatives who had an experience in intentionally assisting their family member's home birth. Data were collected through semi-structured telephone interviews. Nvivo version 11 software was used for data analysis using the Graneheim and Lundman's content analysis.

Results

13 categories and 4 themes emerged. The themes were living with fallacious beliefs in unassisted home childbirths, feeling of socially alienated from the surrounding communities, dealing with limited access to healthcare services, and escaping from childbirth-related stressors.

Conclusion

Home birth with the help of untrained family members takes place because of not only limited access to healthcare services, but also women's personal beliefs, values, and needs. Designing culturally sensitive health education, ensuring culturally competent healthcare workers and services, overcoming healthcare access barriers, and improving the community's pregnancy and childbirth literacies are fundamental in reducing unassisted home births and promoting facility childbirths.

Abuse and humiliation in the delivery room: Prevalence and associated factors of obstetric violence in Ghana

Background

Abuse and mistreatment of women during childbirth is a major barrier to facility-based delivery, putting women at risk of avoidable complications, trauma and negative health outcomes including death. We study the prevalence of obstetric violence (OV) and its associated factors in the Ashanti and Western Regions of Ghana.

Methodology

A facility-based cross-sectional survey was conducted in eight public health facilities from September to December 2021. Specifically, close-ended questionnaires were administered to 1,854 women, aged 15-45 who gave birth in the health facilities. The data collected include the sociodemographic attributes of women, their obstetric history and experiences of OV based on the seven typologies according to the categorization by Bowser and Hills.

Findings

We find that about two in every three women (65.3%) experience OV. The most common form of OV is non-confidential care (35.8%), followed by abandoned care (33.4%), non-dignified care (28.5%) and physical abuse (27.4%). Furthermore, 7.7% of women were detained in health facilities for their inability to pay their bills, 7.5% received non-consented care while 11.0% reported discriminated care. A test for associated factors of OV yielded few results. Single women (OR 1.6, 95% CI 1.2-2.2) and women who reported birth complications (OR 3.2, 95% CI 2.4-4.3) were more likely to experience OV compared with married women and women who had no birth complications. In addition, teenage mothers (OR 2.6, 95% CI 1.5-4.5) were more likely to experience physical abuse compared to older mothers. Rural vs. urban location, employment status, gender of birth attendant, type of delivery, time of delivery, the ethnicity of the mothers and their social class were all not statistically significant.

Conclusion

The prevalence of OV in the Ashanti and Western Regions was high and only few variables were strongly associated with OV, suggesting that all women are at risk of abuse. Interventions should aim at promoting alternative birth strategies devoid of violence and changing the organizational culture of violence embedded in the obstetric care in Ghana.

The tipping point of antenatal engagement: A qualitative grounded theory in Tanzania and Zambia

BACKGROUND

Effective antenatal care is fundamental to the promotion of positive maternal and new-born outcomes. International guidance recommends an initial visit in the first trimester of pregnancy, with a minimum of four antenatal visits in total: the optimum schedule being eight antenatal contacts. In low- and middle-income countries, many women do not access antenatal care until later in pregnancy and few have the recommended number of contacts.

AIM

To gain understanding of women's antenatal experiences in Tanzania and Zambia, and the factors that influence antenatal engagement.

METHODS

The study was underpinned by Strauss's grounded theory methodology. Interviews were conducted with 48 women, 16 partners, 21 health care providers and 11 stakeholders, and analysed using constant comparison.

FINDINGS

The core category was 'The tipping point of antenatal engagement', supported by four categories: awareness of health benefits, experiential motivators, influential support, and environmental challenges. Although participants recognised the importance of antenatal care to health outcomes, individual motivations and external influences determined attendance or non-attendance. The 'tipping point' for antenatal engagement occurred when women believed that any negative impact could be offset by tangible gain. For some women non-attendance was a conscious decision, for others it was an unchallenged cultural norm.

CONCLUSION

A complex interplay of factors determines antenatal engagement. Short-term modifiable factors to encourage attendance include the development of strategies for increasing respectful care; use of positive women's narratives, and active community engagement. Further research is required to develop innovative, cost-effective care models that improve health literacy and meet women's needs.

Community's experience and perceptions of maternal health services across the continuum of care in Ethiopia: A qualitative study

BACKGROUND

Continuum of care is an effective strategy to ensure that every woman receives a series of maternal health services continuously from early pregnancy to postpartum stages. The community perceptions regarding the use of maternal services across the continuum of care are essential for utilization of care in low-income settings but information in that regard is scanty. This study explored the community perceptions on the continuum of care for maternal health services in Ethiopia.

METHODS

This study employed a phenomenological qualitative research approach. Four focus group discussions involving 26 participants and eight in-depth interviews were conducted with women who recently delivered, community health workers, and community leaders that were purposively selected for the study in West Gojjam zone, Amhara region. All the interviews and discussions were audio-taped; the records were transcribed verbatim. Data were coded and analyzed thematically using ATLAS.ti software.

RESULTS

We identified three primary themes: practice of maternal health services; factors influencing the decision to use maternal health services; and reasons for discontinuation across the continuum of maternal health services. The study showed that women faced multiple challenges to continuously uptake maternal health services. Late antenatal care booking was the main reasons for discontinuation of maternal health services across the continuum at the antepartum stage. Women's negative experiences during care including poor quality of care, incompetent and unfriendly health providers, disrespectful care, high opportunity costs, difficulties in getting transportation, and timely referrals at healthcare facilities, particularly at health centers affect utilization of maternal health services across the continuum of care. In addition to the reverberation effect of the intrapartum care factors, the major reasons mentioned for discontinuation at the postpartum stage were lack of awareness about postnatal care and service delivery modality where women are not scheduled for postpartum consultations.

CONCLUSION

This study showed that rural mothers still face multiple challenges to utilize maternal health services as recommended by the national guidelines. Negative experiences women encountered in health facilities, community perceptions about postnatal care services as well as challenges related to service access and opportunity costs remained fundamental to be reasons for discontinuation across the continuum pathways.

Challenges experienced by midwives working in rural communities in the Upper East Region of Ghana: a qualitative study

Background

In 2017, a total of 295,000 women lost their lives due to pregnancy and childbirth across the globe, with sub-Saharan Africa and South Asia accounting for approximately 86 % of all maternal deaths. The maternal mortality ratio in Ghana is exceptionally high, with approximately 308 deaths/100,000 live births in 2017. Most of these maternal deaths occur in rural areas than in urban areas. Thus, we aimed to explore and gain insights into midwives’ experiences of working and providing women-centred care in rural northern Ghana.

Methods

A qualitative descriptive exploratory design was used to explore the challenges midwives face in delivering women-centred midwifery care in low-resource, rural areas. A total of 30 midwives practicing in the Upper East Region of Ghana were purposefully selected. Data were collected using individual semistructured interviews and analysed through qualitative content analysis.

Results

Five main themes emerged from the data analysis. These themes included were: inadequate infrastructure (lack of bed and physical space), shortage of midwifery staff, logistical challenges, lack of motivation, and limited in-service training opportunities.

Conclusions

Midwives experience myriad challenges in providing sufficient women-centred care in rural Ghana. To overcome these challenges, measures such as providing adequate beds and physical space, making more equipment available, and increasing midwifery staff strength to reduce individual workload, coupled with motivation from facility managers, are needed.

Methods used to measure maternal mortality in Sub-Saharan Africa from 1980 to 2020: A systematic literature review

BACKGROUND

Gobally, Sub-Saharan Africa (SSA) has the largest maternal mortality burden, but the region lacks accurate data.

OBJECTIVE

To review methods historically used to measure maternal mortality in SSA to inform future study methods.

SEARCH STRATEGY

We searched databases: PubMed, Medline, WorldCat and CINHAL, using keywords "maternal mortality," "pregnancy-related death," "reproductive age mortality," "ratio," "rate," and "risk," using Boolean operators "OR" and "AND" to combine the search terms.

SELECTION CRITERIA

We searched for empirical and analytical studies that: (1) measured maternal mortality levels, (2) were in SSA, (3) reported original results, and (4) were not duplicate studies. We included studies published in English since 1980.

DATA COLLECTION AND ANALYSIS

We screened the studies using titles and abstracts, reading the full text of selected studies. We analyzed the estimates and strengths, and limitations of the methods.

MAIN RESULTS

We identified 96 studies that used nine methods: demographic surveillance (n = 4), health record reviews (n = 18), confidential enquiries and maternal death surveillance and response (n = 7), prospective cohort (n = 9), reproductive age mortality survey (RAMOS) (n = 6), sisterhood method (n = 35), mixed methods (n = 4), and mathematical modeling (n = 13).

CONCLUSION

Sisterhood method studies and RAMOS studies that combined institutional records and community data produced maternal mortality ratios more comparable with WHO estimates.

How do pregnant women and new mothers navigate and respond to challenges in accessing health care? Perspectives from rural South Africa

Women in low- and middle-income countries and in contexts characterized by inequality face various interpersonal and structural barriers when accessing formal maternal and child health (MCH) services. These barriers persist even in contexts where programs to increase access to services, such as community health worker (CHW) interventions, have been implemented. However, while barriers to accessing care have been extensively documented, less is known about the diverse ways that women respond to, and navigate, these situations. This study explores strategies pregnant women and new mothers use to navigate and respond to health care barriers in a rural district in the Eastern Cape, South Africa. Twenty-six pregnant or recently delivered clients of the Enable Mentor Mother program were interviewed about their experiences of accessing formal MCH services. Interviews were conducted between February-March 2018 by an experienced isiXhosa-speaking research assistant, translated and transcribed into English, with transcripts coded and organized by themes using ATLAS.ti software. Facing resource shortages, inconsistent communication, and long travel times to clinics, participants employed diverse, innovative strategies to navigate interpersonal and structural barriers to care. While some participants chose to respond to barriers more passively-citing endurance and acceptance as practices of health system engagement-those participants who focused more on active responses tended to leverage their education, existing relationships, and available community resources to overcome barriers. Nevertheless, most participants described feelings of frustration and dejection. While CHW interventions may alleviate some of the burdens facing fragile health care systems in these contexts, these programs still rely on an underlying infrastructure of care that primary health care clinics and hospitals should be providing. Future programming should work in tandem with formal health systems and should support staff to improve quality of care provided to pregnant women, new mothers, and their infants to prioritize their health at a time of vulnerability.