DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20220684

Perceptions of users and providers on barriers to utilizing skilled birth care in Surkhet district of Nepal: a qualitative study

Sunil Shah

Abstract


Background: Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. 

Method: We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers.

Results: Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities.

Conclusions: Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.


Keywords


Skilled birth care, Utilization, SBAs, Barrier, Qualitative, Nepal

Full Text:

PDF

References


United Nations. The Millennium Development Goals Report. New York: United Nations. 2011.

World Health Organization. World health statistics. Geneva: World Health Organization. 2012.

Skilled Attendance at Birth. Available at: http://www.unfpa.org/public/cache/offonce/home/mothers/pid/4383. Accessed on 12 March 2014.

New Era, Macro International. Trends in demographic and reproductive health indicators in Nepal 2006, further analysis of the 1996, 2001, and 2006 Demographic and Health Survey Data. Calverton: New Era. 2007.

National Planning Commission. Millennium Development Goals needs assessment for Nepal. Kathmandu: UNDP. 2012.

Support to Safe Motherhood Program. Maternal and perinatal death review 2008. Kathmandu: SSMP. 2008.

Family Health Division. Safe motherhood policy. Kathmandu: FHD. 1998.

Government of Nepal. Operational guidelines on incentives for safe delivery services. Kathmandu: MoHP. 2005.

Family Health Division. National policy on skilled birth attendants. Kathmandu: FHD. 2006.

Family Health Division. National safe motherhood and newborn health long term plan (20062017). Kathmandu: FHD. 2006.

MoHP. The Aama Programme: an initiative towards reducing maternal and newborn deaths in Nepal. Kathmandu: Ministry of Health and Population. 2010.

Witter S, Khadka S, Nath H, Tiwari S. The national free delivery policy in Nepal: early evidence of its effects on health facilities. Health Policy Plan. 2011;26: ii84-91.

New Era. Nepal Family Health Survey. Kathmandu: New Era. 1996.

Ministry of Health and Population (MoHP) [Nepal], New Era, ICF International Inc. Nepal Demographic and Health Survey 2011. Calverton: MoHP. 2012.

Choulagai B, Onta S, Subedi N, Mehata S, Bhandari G, Poudyal A et al. Barriers to using skilled birth attendants’ services in mid- and far-western Nepal: a cross sectional study. BMC Int Health Hum Rights. 2013;13:49.

Krefting L. Rigor in qualitative research: the assessment of trustworthiness. Am J Occup Ther. 1990;45:21422.

Grant MJ. Writing academic papers: lost in translation? Health Info Libr J. 2011;28:2478.

Mayring P. Qualitative content analysis. Forum Qual Soc Res 2000; 1. Available at: http://www.qualitative-research.net/index.php/fqs/article/view/1089/2385. Accessed 8, February 2014.

Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091110.

Ensor T, Cooper S. Overcoming barriers to health service access: influencing the demand side. Health Policy Plan. 2004;19:6979.

Hancock B, Windridge K, Ockleford E. An introduction to qualitative research. The NIHR RDS EM/YH. UK: University of Birmingham and University of Leicester. 2007.

Mpembeni RN, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D et al. Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets. BMC Pregnancy Childbirth. 2007;7:29.

Titaley CR, Hunter CL, Dibley MJ, Heywood P. Why do some women still prefer traditional birth attendants and home delivery? A qualitative study on delivery care services in West Java Province, Indonesia. BMC Pregnancy Childbirth. 2010;10:43.

Morrison J, Thapa R, Basnet M, Budhathoki B, Tumbahangphe K, Manandhar D et al. Exploring the first delay: a qualitative study of home deliveries in Makwanpur District, Nepal. BMC Pregnancy Childbirth. 2014;14:89.

Gebrehiwot T, Sebastian MS, Edin K, Goicolea I. Health workers’ perceptions of facilitators of and barriers to institu-tional delivery in Tigray, Northern Ethiopia. BMC Pregnancy Childbirth. 2014;14:137.

Simkhada B, Porter M, Teijlingen E. The role of mothers-in-law in antenatal care decision-making in Nepal: a qualitative study. BMC Pregnancy Childbirth. 2010;10:34.

Singh P, Rai R, Alagarajan M, Singh L. Determinants of maternity care services utilization among married adolescents in rural India. PLoS One. 2011;7:2.

Agha S, Carton TW. Determinants of institutional delivery in rural Jhang, Pakistan. Int J Equity Health. 2011;10:31.

Edmonds J, Paul M, Sibley L. Determinants of place of birth decisions in uncomplicated childbirth in Bangladesh: an empir-ical study. Midwifery. 2012;28:55460.

Kumbani L, Bjune G, Chirwa E, Malata A, Odland J. Why some women fail to give birth at health facilities: a qualitative study of women’s perceptions of perinatal care from rural Southern Malawi. BMC Reprod Health. 2013;10:9.