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

Abstract

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