Home delivery and associated factors in an urban context A qualitative study in Hawassa City, Southern Ethiopia

Abstract

Background: Pregnancy and childbirth are mark of identity for women. These important processes, however, entailchallenges that are of public concern. Despite endeavors to improve maternal health in Ethiopia, still majority ofwomen tend to deliver at home with life threatening consequences. The problem becomes more pronounced whenurban women who are relatively aware of maternal health problems and who have relative access to services tend todeliver at home. Objective: The study aims to explore why women in Hawassa City prefer to deliver at home and identify associatedreasons. Methods: An exploratory study was carried out in Hawassa during mid-2012, using qualitative method. Women whodelivered their recent child at a health facility and at home, health professionals at management and service deliverylevels, local opinion leaders and husbands participated in the study. Data was collected by trained research assistantsand analyzed by classifying the findings into themes and sub-themes, guided by the objective of the study. Findingsfrom different sources were triangulated, interpreted and presented. Results: Research participants believe pregnancy and delivery are normal processes in marital life. However, visit tohealth facility is recognized to be triggered by unusual ill feelings during pregnancy or labor. Even those whodelivered their recent child assisted by skilled attendants at health facility reported to have done so due to healthconcerns. Decision on maternal health service utilization is found to be determined by individual, community andfacility level factors. At individual level, socio-demographic characteristics, recognition of pregnancy and delivery asnormal process and previous experiences were found to determine the decision to use available services. Similarly atcommunity level, the understanding that pregnancy and delivery are normal and natural processes and recognition ofhome as a natural environment for delivery was widespread. Consolidating such understanding and justifying women’sdecision to deliver at home was caused by unfriendly service providers at health facilities and associated cost ofservices. Conclusions: Despite endeavors to improve maternal health services and ensure skilled delivery at all levels, womenas well as members of the community still preferred home delivery. Individual, community and institutional factorswork in tandem to affect women’s decision to deliver at home. Ameliorating these problems requires comprehensiveapproaches that address the wide ranging factors at the same time. [Ethiop. J. Health Dev. 2015;29(1):3-12]