Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis View Full Text


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Article Info

DATE

2014-09-19

AUTHORS

Meghan A Bohren, Erin C Hunter, Heather M Munthe-Kaas, João Paulo Souza, Joshua P Vogel, A Metin Gülmezoglu

ABSTRACT

High-quality obstetric delivery in a health facility reduces maternal and perinatal morbidity and mortality. This systematic review synthesizes qualitative evidence related to the facilitators and barriers to delivering at health facilities in low- and middle-income countries. We aim to provide a useful framework for better understanding how various factors influence the decision-making process and the ultimate location of delivery at a facility or elsewhere. We conducted a qualitative evidence synthesis using a thematic analysis. Searches were conducted in PubMed, CINAHL and gray literature databases. Study quality was evaluated using the CASP checklist. The confidence in the findings was assessed using the CERQual method. Thirty-four studies from 17 countries were included. Findings were organized under four broad themes: (1) perceptions of pregnancy and childbirth; (2) influence of sociocultural context and care experiences; (3) resource availability and access; (4) perceptions of quality of care. Key barriers to facility-based delivery include traditional and familial influences, distance to the facility, cost of delivery, and low perceived quality of care and fear of discrimination during facility-based delivery. The emphasis placed on increasing facility-based deliveries by public health entities has led women and their families to believe that childbirth has become medicalized and dehumanized. When faced with the prospect of facility birth, women in low- and middle-income countries may fear various undesirable procedures, and may prefer to deliver at home with a traditional birth attendant. Given the abundant reports of disrespectful and abusive obstetric care highlighted by this synthesis, future research should focus on achieving respectful, non-abusive, and high-quality obstetric care for all women. Funding for this project was provided by The United States Agency for International Development (USAID) and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization. More... »

PAGES

71

References to SciGraph publications

  • 2012-04-11. Husbands' involvement in delivery care utilization in rural Bangladesh: A qualitative study in BMC PREGNANCY AND CHILDBIRTH
  • 2013-01-16. Why do women prefer home births in Ethiopia? in BMC PREGNANCY AND CHILDBIRTH
  • 2005-12-13. Maternal Health-Seeking Behavior and Associated Factors in a Rural Nigerian Community in MATERNAL AND CHILD HEALTH JOURNAL
  • 2010-03-19. High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention in BMC PREGNANCY AND CHILDBIRTH
  • 2010-08-11. Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia in BMC PREGNANCY AND CHILDBIRTH
  • 2014-01-01. “It’s up to the Woman’s People”: How Social Factors Influence Facility-Based Delivery in Rural Northern Ghana in MATERNAL AND CHILD HEALTH JOURNAL
  • 2010-01-07. Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia in BMC PREGNANCY AND CHILDBIRTH
  • 2012-02-23. ‘A Normal Delivery Takes Place at Home’: A Qualitative Study of the Location of Childbirth in Rural Ethiopia in MATERNAL AND CHILD HEALTH JOURNAL
  • 2012-10-19. Making pragmatic choices: women’s experiences of delivery care in Northern Ethiopia in BMC PREGNANCY AND CHILDBIRTH
  • 2012-03-20. Home birth and barriers to referring women with obstetric complications to hospitals: a mixed-methods study in Zahedan, southeastern Iran in REPRODUCTIVE HEALTH
  • 2008-12-05. Childbirth practices in rural Rajasthan, India: implications for neonatal health and survival in JOURNAL OF PERINATOLOGY
  • 2012-11-27. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ in BMC MEDICAL RESEARCH METHODOLOGY
  • 2012-01-03. Analysis of human immune responses in quasi-experimental settings: tutorial in biostatistics in BMC MEDICAL RESEARCH METHODOLOGY
  • Identifiers

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    31 schema:description High-quality obstetric delivery in a health facility reduces maternal and perinatal morbidity and mortality. This systematic review synthesizes qualitative evidence related to the facilitators and barriers to delivering at health facilities in low- and middle-income countries. We aim to provide a useful framework for better understanding how various factors influence the decision-making process and the ultimate location of delivery at a facility or elsewhere. We conducted a qualitative evidence synthesis using a thematic analysis. Searches were conducted in PubMed, CINAHL and gray literature databases. Study quality was evaluated using the CASP checklist. The confidence in the findings was assessed using the CERQual method. Thirty-four studies from 17 countries were included. Findings were organized under four broad themes: (1) perceptions of pregnancy and childbirth; (2) influence of sociocultural context and care experiences; (3) resource availability and access; (4) perceptions of quality of care. Key barriers to facility-based delivery include traditional and familial influences, distance to the facility, cost of delivery, and low perceived quality of care and fear of discrimination during facility-based delivery. The emphasis placed on increasing facility-based deliveries by public health entities has led women and their families to believe that childbirth has become medicalized and dehumanized. When faced with the prospect of facility birth, women in low- and middle-income countries may fear various undesirable procedures, and may prefer to deliver at home with a traditional birth attendant. Given the abundant reports of disrespectful and abusive obstetric care highlighted by this synthesis, future research should focus on achieving respectful, non-abusive, and high-quality obstetric care for all women. Funding for this project was provided by The United States Agency for International Development (USAID) and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization.
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