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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Home deliveries in the capital: a qualitative exploration of barriers to institutional deliveries in peri-urban areas of Lusaka, Zambia

Authors: Tamara Mulenga, Misinzo Moono, Martha Mwendafilumba, Albert Manasyan, Anjali Sharma

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

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Abstract

Background

A shortage of skilled birth attendants and low quality of care in health facilities along with unattended home deliveries contribute to the high maternal and neonatal mortality in sub Saharan Africa. Identifying and addressing context-specific reasons for not delivering at health care facilities could increase births assisted by skilled attendants who, if required, can provide life-saving interventions.

Methods

We conducted 22 in-depth interviews (IDIs) with midwives at three health facilities in peri-urban communities and 24 semi-structured surveys with mothers in two areas served by health facilities with the highest number of reported home deliveries in Lusaka, Zambia. Both IDIs and surveys were audio-recorded, transcribed and coded to identify themes around delivery and birthing experience.

Results

We found that most women preferred institutional deliveries to home deliveries, but were unable to utilize these services due to inability to recognize labour symptoms or lack of resources. Midwives speculated that women used herbal concoctions to reduce the duration of delivery with the result that women either did not present in time or endangered themselves and the baby with powerful contractions and precipitous labour. Respondents suggested that disrespectful and abusive maternity care dissuaded some women from delivering at health facilities. However, some midwives viewed such tactics as necessary to ensure women followed instructions and successfully delivered live babies.

Conclusion

Difference in beliefs and birthing practices between midwives and mothers suggest the need for open dialogue to co-design appropriate interventions to increase facility usage. Further examination of the pharmaceutical properties and safety of herbal concoctions being used to shorten labour are required. Measures to reduce the economic burden of care seeking within this environment, increase respectful and patient-centred care, and improve the quality of midwifery could increase institutional deliveries.
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Literature
1.
Kassebaum NJ, Barber RM, Bhutta ZA, Dandona L, Gething PW, Hay SI, Kinfu Y, Larson HJ, Liang X, Lim SS, Lopez AD. Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016;388(10053):1775–812.CrossRef
2.
Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C, Say L. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet. 2016;387(10017):462–74.CrossRefPubMed
3.
4.
Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, Lawn JE, Cousens S, Mathers C, Black RE. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the sustainable development goals. Lancet. 2017;388(10063):3027–35.CrossRef
5.
Wall SN, Lee AC, Carlo W, Goldenberg R, Niermeyer S, Darmstadt GL, Keenan W, Bhutta ZA, Perlman J, Lawn JE. Reducing intrapartum-related neonatal deaths in low-and middle-income countries—what works?. In Seminars in perinatology 2010;34(6):395–407).
6.
Belay A, Sendo E. Factors determining choice of delivery place among women of child bearing age in dega damot district, north west of Ethiopia: a community based cross-sectional study. BMC Pregnancy Childbirth. 2016;16(1):229.CrossRefPubMedPubMedCentral
7.
Gitonga E, Muiruri F. Determinants of health facility delivery among women in tharaka nithi county kenya. Pan Afr Med J. 2016;25(2):9.PubMedPubMedCentral
8.
Darmstadt GL, Marchant T, Claeson M, Brown W, Morris S, Donnay F, Taylor M, Ferguson R, Voller S, Teela KC, Makowiecka K. A strategy for reducing maternal and newborn deaths by 2015 and beyond. BMC Pregnancy Childbirth. 2013 Dec;13(1):216.CrossRefPubMedPubMedCentral
9.
World Population Prospects the 2015 Revision. Maternal mortality in 1990–2015: Zambia. In: Affairs DoEaS. New York: United Nations Secretariat; 2015. p. 5.
10.
Lagarde M, Barroy H, Palmer N. Assessing the effects of removing user fees in Zambia and Niger. J health Serv Res Policy. 2012;17(1):30–6.CrossRefPubMed
11.
12.
Ensor T, Green C, Quigley P, Badru AR, Kaluba D, Kureya T. Mobilizing communities to improve maternal health: results of an intervention in rural Zambia. Bull World Health Organ. 2014;92(1):51–9.CrossRefPubMed
13.
14.
Maimbolwa MC, Yamba B, Diwan V, Ransjö-Arvidson AB. Cultural childbirth practices and beliefs in Zambia. J Adv Nurs. 2003;43(3):263–74.CrossRefPubMed
15.
16.
17.
18.
Central Statistics Office. 2010 census of population and housing: National analytic report [online]. Lusaka: CentralStatisticsOffice; 2012.
19.
Central Satistics Office (CSO). Zambia demographic and health survey 2013–14. In: Central Statistics Office MoH. Lusaka: ICF International; 2014.
20.
Directorate of Policy and Planning. 2012 list of health facilities in zambia [online]. Lusaka: Ministry of Health; 2013.
21.
United Nations. Glossary of environment statistics, studies in methods. NY: United nations new York; 1997.
22.
Robinson OC. Sampling in interview-based qualitative research: a theoretical and practical guide. Qual Res Psychol. 2014;11(1):25–41.CrossRef
23.
Gray DE. Doing research in the real world. 3. London: SAGE; 2014.
24.
d'Oliveira AFPL, Diniz SG, Schraiber LB. Violence against women in health-care institutions: an emerging problem. Lancet. 2002;359(9318):1681–5.CrossRefPubMed
25.
Bowser D, Hill K. Exploring evidence for disrespect and abuse in facility-based childbirth. Boston: USAID-TRAction project, Harvard school of Public Health; 2010.
26.
27.
Kittle B. A practical guide to conducting a barrier analysis. New York: Helen Keller international; 2013.
28.
Vaismoradi M, Jones J, Turunen H, Snelgrove S. Theme development in qualitative content analysis and thematic analysis. J Nursing Education Practice. 2016;6(5):100.CrossRef
29.
Patton MQ. Qualitative research & evaluation methods. Thousand oaks sage publications. New York, New Delhi, London; 2002.
30.
La Pelle N. Simplifying qualitative data analysis using general purpose software tools. Field Methods. 2004;16(1):85–108.CrossRef
31.
Gabrysch S, Campbell OMR. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth. 2009;9(1):34.CrossRefPubMedPubMedCentral
32.
Sasaki S, Igarashi K, Fujino Y, Comber AJ, Brunsdon C, Muleya CM, et al. The impact of community-based outreach immunisation services on immunisation coverage with gis network accessibility analysis in peri-urban areas, Zambia. J Epidemiol Community Health. 2011;65(12):1171–8.CrossRefPubMed
33.
Veale DJ, Furman KI, Oliver DW. South african traditional herbal medicines used during pregnancy and childbirth. J Ethnopharmacol. 1992;36(3):185–91.CrossRefPubMed
34.
Kamatenesi-Mugisha M, Oryem-Origa H. Medicinal plants used to induce labour during childbirth in western Uganda. J Ethnopharmacol. 2007;109(1):1–9.CrossRefPubMed
35.
Rominski SD, Lori J, Nakua E, Dzomeku V, Moyer CA. When the baby remains there for a long time, it is going to die so you have to hit her small for the baby to come out: justification of disrespectful and abusive care during childbirth among midwifery students in Ghana. Health Policy Plan. 2017;32(2):215–24.PubMed
36.
McMahon SA, George AS, Chebet JJ, Mosha IH, Mpembeni RNM, Winch PJ. Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro region, Tanzania. BMC Pregnancy Childbirth. 2014;14(1):268.CrossRefPubMedPubMedCentral
37.
Mannava P, Durrant K, Fisher J, Chersich M, Luchters S. Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review. Glob Health. 2015;11(1):36.CrossRef
38.
Sheferaw ED, Bazant E, Gibson H, Fenta HB, Ayalew F, Belay TB, et al. Respectful maternity care in ethiopian public health facilities. Reprod Health. 2017;14(1):60.CrossRefPubMedPubMedCentral
39.
Wesevich A, Chipungu J, Mwale M, Bosomprah S, Chilengi R. Health promotion through existing community structures: a case of churches’ roles in promoting rotavirus vaccination in rural Zambia. J Primary Care Community Health. 2016;7(2):81–7.CrossRef
Metadata
Title
Home deliveries in the capital: a qualitative exploration of barriers to institutional deliveries in peri-urban areas of Lusaka, Zambia
Authors
Tamara Mulenga
Misinzo Moono
Martha Mwendafilumba
Albert Manasyan
Anjali Sharma
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1837-7

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