Barriers to Skilled Birth Attendance: A Survey among Mothers in Rural Gambia
Abstract
The objectives of this cross-sectional survey were to identify the most important barriers for use of skilled attendance during childbirth by women in rural Gambia. We also assessed information received during antenatal care, preparations made prior to childbirth, and experiences and perceptions that may influence the use of skilled birth attendance in rural Gambia. The most frequently stated barriers for giving birth in a health facility were not having enough time to go (75%), and lack of transport (29%). The majority of the women (83%) stated that they preferred having a health worker attending their childbirth. More than seventy percent of the participants gave birth attended by a traditional birth attendant, but only 27% had intended to give birth at home. Sixty-four percent had made advance arrangements for the childbirth. Only 22% were informed about expected time of birth during antenatal care. Our findings suggest that the participants hold the knowledge and motivation that is necessary if practices are to be changed. Interventions aiming at ensuring timely transport of women to health facilities seem key to increased use of skilled birth attendants. (Afr J Reprod Health 2014; 18[1]: 35-43).
Keywords: Childbirth, maternal health services, access, barriers, birth preparedness, complication readiness
Résumé
Les objectifs de cette étude transversale étaient d'identifier les obstacles les plus importants pour se servir des accoucheuses qualifiées lors de l'accouchement. Nous avons également évalué les informations reçues lors des soins prénatals, les préparatifs effectués avant l'accouchement, et les expériences et les perceptions qui peuvent influer sur l'utilisation des accoucheuses qualifiées en Gambie rurale. Les obstacles les plus souvent mentionnés pour accoucher dans un établissement de santé de ne pas avoir assez de temps pour y aller (75 %), et le manque de transport (29 %). La majorité des femmes (83%) ont déclaré qu'elles préféraient avoir les services du personnel médical pendant leur accouchement. Plus de soixante-dix pour cent des participantes ont accouché à l’aide d’une accoucheuse traditionnelle, mais seulement 27 % avaient l'intention d’accoucher à la maison. Soixante-quatre pour cent avaient pris des dispositions à l'avance pour l'accouchement. Seulement 22 % ont été informées de l'heure prévue de l’accouchement au cours des soins prénatals. Nos résultats indiquent que les participantes possèdent les connaissances et la motivation qui sont nécessaires si les pratiques doivent être modifiées. Les interventions visant à assurer le transport en temps opportun des femmes aux établissements de santé semblent être la clé pour accroître l'utilisation des accoucheuses qualifiées. (Afr J Reprod Health 2014; 18[1]: 35-43).
Mots-clés: accouchement, services de santé maternelle, accès, barrières, préparation pour l’accouchement, préparation pour la complication
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World Health Organization, United Nations Children's Fund, United Nations Population Fund, The World Bank. Trends in maternal mortality: 1990 to 2008. Estimates developed by WHO, UNICEF, UNFPA and
The World Bank. World Health Organization, Geneva, 2010.
Kunst AE and Houweling T. A global picture of poor-rich differences in the utilisation of delivery care. In Safe motherhood strategies: a review of the evidence. In: De Brouwere V, Van Lerberghe W (Ed.). Antwerp: ITGPress, 2001, 297-315.
United Nations: United Nations millennium declaration. 2000: http://www.un.org/millennium/declaration/ares 552e.htm (accessed Feb 2, 2011).
United Nations: Millennium development goals indicators. The official United Nations site for the Millennium Development Goals indicators. 2008: http://mdgs.un.org/unsd/mdg/Host.aspx?Content=Indi cators/OfficialList.htm (accessed Jan 13, 2011).
Campbell O and Graham W. Strategies for reducing maternal mortality: getting on with what works. Lancet 2006; 368(9543): 1284-99.
World Health Organization: Reduction of maternal mortality: a joint WHO/UNFPA/UNICEF/World Bank statement. World Health Organization, Geneva, 1999.
Adegoke AA and van den Broek N. Skilled birth attendance-lessons learnt. BJOG 2009; 116 (Suppl 1): 33-40.
JHPIEGO. Monitoring birth preparedness and complication readiness: tools and indicators for maternal and newborn health. JHPIEGO, Baltymore, 2004.
Gabrysch S and Campbell OM. Still too far to walk. literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 2009; 9: 34.
United Nations Development Programme. Human development report 2010 - 20th anniversary edition. The real wealth of nations: pathways to human development. UNDP, New York, 2010.
The World Bank. Health and poverty in the Gambia. A background report to the national poverty reduction strategy paper. The World Bank, 2005.
Telfer ML, Rowley JT and Walraven GE. Experiences of mothers with antenatal, delivery and postpartum care in rural Gambia. Afr J Reprod Health 2002; 6(1): 7483.
World Health Organization. WHO Country cooperation strategy 2008-2013. World Health Organization, Geneva, 2009.
Department of State for Health. Health is wealth. Department of State for Health. Banjul, 2006.
Amooti-Kaguna B and Nuwaha F. Factors influencing choice of delivery sites in Rakai district of Uganda. Soc Sci Med 2000; 50(2): 203-13.
Cham M, Sundby J and Vangen S. Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care. Reprod Health 2005; 2(1):3.
Nyanzi S. Empowering traditional birth attendants in The Gambia: a local strategy to redress issues of access, equity and sustainability? In: Sama M, Nguyen V-K (Ed.). Governing health system in Africa. Dakar: Codesria, 2008, 225-34.
Otis KE and Brett JA. Barriers to hospital births: why do many Bolivian women give birth at home? Rev Panam Salud Publica 2008; 24(1): 46-53.
Bazzano AN, Kirkwood B, Tawiah-Agyemang C, OwusuAgyei S and Adongo P. Social costs of skilled attendance at birth in rural Ghana. Int J Gynaecol Obstet 2008; 102(1): 91-4.
Thaddeus S and Maine D. Too far to walk. maternal mortality in context. Soc Sci Med 1994; 38(8): 1091110.
Matsuoka S, Aiga H, Rasmey LC, Rathavy T and Okitsu A. Perceived barriers to utilization of maternal health services in rural Cambodia. Health policy 2010; 95(23): 255-63.
Filippi V, Richard F, Lange I and Ouattara F. Identifying barriers from home to the appropriate hospital through near-miss audits in developing countries. Best Pract Res Clin Obstet Gynaecol 2009; 23(3): 389-400.
Seljeskog L, Sundby J and Chimango J. Factors influencing women's choice of place of delivery in rural Malawi-an explorative study. Afr J Reprod Health 2006; 10(3): 66-75.
Mills S and Bertrand JT. Use of health professionals for obstetric care in northern Ghana. Stud Fam Plann 2005; 36(1): 45-56.
Jammeh A, Sundby J and Vangen S. Barriers to emergency obstetric care services in perinatal deaths in rural gambia: a qualitative in-depth interview study. ISRN Obstet Gynecol 2011, Epub 2011.
bij de Vaate A, Coleman R, Manneh H and Walraven G. Knowledge, attitudes and practices of trained traditional birth attendants in the Gambia in the prevention, recognition and management of postpartum haemorrhage. Midwifery 2002; 18(1): 311.
Anya SE, Hydara A and Jaiteh LE. Antenatal care in The Gambia: missed opportunity for information, education and communication. BMC Pregnancy
Childbirth 2008; 8(9).
Moran AC, Sangli G, Dineen R, Rawlins B, Yamèogo M and Baya B. Birth-preparedness for maternal health: findings from Koupéla district, Burkina Faso. J Health Popul Nutr 2006; 24(4): 489-97.
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