Thousands of women and newborns still die preventable deaths
from pregnancy and childbirth-related complications in poor settings. Delivery
with a skilled birth attendant is a vital intervention for saving lives. Yet
many women, particularly where maternal mortality ratios are highest, do not
have a skilled birth attendant at delivery. In Uganda, only 58 % of women
deliver in a health facility, despite approximately 95 % of women
attending antenatal care (ANC).
This study aimed to (1) identify key factors
underlying the gap between high rates of antenatal care attendance and much
lower rates of health-facility delivery; (2) examine the association between
advice during antenatal care to deliver at a health facility and actual place
of delivery; (3) investigate whether antenatal care services in a post-conflict
district of Northern Uganda actively link women to skilled birth attendant
services; and (4) make recommendations for policy- and program-relevant
implementation research to enhance use of skilled birth attendance services.
This study was carried out in Gulu District in 2009.
Quantitative and qualitative methods used included: structured antenatal care
client entry and exit interviews [n = 139];
semi-structured interviews with women in their homes [n = 36], with health
workers [n = 10], and with policymakers [n = 10]; and focus group discussions
with women [n = 20], men [n = 20], and traditional birth attendants [n = 20].
Seventy-five percent of antenatal care clients currently
pregnant reported they received advice during their last pregnancy to deliver
in a health facility, and 58 % of these reported having delivered in a
health facility. After adjustment for confounding, women who reported they
received advice at antenatal care to deliver at a health facility were
significantly more likely (aOR = 2.83 [95 % CI: 1.19–6.75], p = 0.02)
to report giving birth in a facility. Despite high antenatal care coverage, a
number of demand and supply side barriers deter use of skilled birth attendance
services. Primary barriers were: fear of being neglected or maltreated by
health workers; long distance and other difficulties in access; poverty, and
material requirements for delivery; lack of support from husband/partner;
health systems deficiencies such as inadequate staffing/training, work
environment, and referral systems; and socio-cultural and gender issues such as
preferred birthing position and preference for traditional birth attendants.
Initiatives to improve quality of client-provider
interaction and respect for women are essential. Financial barriers must be
abolished and emergency transport for referrals improved. Simultaneously,
supply-side barriers must be addressed, notably ensuring a sufficient number of
health workers providing skilled obstetric care in health facilities and
creating habitable conditions and enabling environments for them.
Below: Factors influencing the link or gap between women’s use of ANC and SBA services) uploaded through the online submission system
Full article at: http://goo.gl/UlZN9L
By:
1United Nations Population Fund (UNFPA), 605
Third Avenue, New York 10158, NY, USA
2London School of Hygiene & Tropical
Medicine, London, UK
3Institutes of Tropical Medicine and
International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
4Gulu University Faculty of Medicine, Gulu,
Uganda
5Medicos sin Fronteras (MSF/Doctors Without
Borders) - Spain/OCBA, Barcelona, Spain
6Apac Hospital, Apac, Uganda
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