BMC Pregnancy and Childbirth: A qualitative exploration of barriers to institutional deliveries in peri-urban areas of Lusaka, Zambia

2 January, 2019

Dear HIFA and HIFA-Zambia colleagues,

(with thanks to John Eyers, HIFA literature search expert volunteer)

This paper finds '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'. Also, '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.'

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

BMC Pregnancy and Childbirth. 18 (1) (no pagination), 2018.

Author: Mulenga T.; Moono M.; Mwendafilumba M.; Manasyan A.; Sharma A.

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.

SELECTED EXTRACT

“Even the African syntocinon, the herbal concoction that they drink in order to help them deliver quickly … When a woman is given such concoctions, they normally deliver placentas that are a bit greenish … Most of the babies that I have seen from women who have confessed to have drunk such traditional medicine, we have to resuscitate the babies at birth … It will give a woman such strong contractions, such that a woman may even have a ruptured uterus …”. (IDI, Health Facility B, Midwife 3)

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Best wishes, Neil

Coordinator, HIFA Project on Information for Citizens, Parents and Children:

http://www.hifa.org/projects/citizens-parents-and-children

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG /orcid.org/0000-0001-9557-1487 neil@hifa.org