Women’s perspectives on the measures that need to be taken to increase the use of health-care facility delivery service among slums women, Addis Ababa, Ethiopia: a qualitative study

Abstract

Abstract

Background Global strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery along with access to emergency obstetric care. Research that examines strategies to increase facility-based skilled birth attendance among slum residents in Addis Ababa, Ethiopia, is limited.

Objective The study aimed to explore women's perspectives on the measures that need to be taken to increase the use of the facility—delivery service among slums women, Addis Ababa, Ethiopia

Methods Qualitative exploratory and descriptive research designs were used. Participants in the study were women in the reproductive age group (18–49 years of age) living in the slum areas of Addis Ababa, Ethiopia. A purposive sampling strategy was used to select study participants. Potential participants' names were gathered from health facilities and followed to their homes for the study. Four audio-recorded focus group discussions [FGDs] were conducted with 32 participants from the three public health centers and one district hospital. The number of participants in FGDs was between 6 and 10 women. Data were analyzed simultaneously with data collection. Thematic analysis was used in data analysis, which entails three interconnected stages: data reduction, data display, and data conclusion. In addition, thematic analysis entailed evaluating the structure and content of textual data, identifying data themes, coding the themes, and then interpreting the structure and content of the themes. A codebook was first devised, discussed, and adopted by the writers before they could use this technique. Using the codebook, the theme codes were then manually produced. To explain the study results, verbatim excerpts from participants were given. The researcher used Techs' eight steps of qualitative data analysis method for analyzing the data. A multi-level life-course framework of facility-based delivery in low- and middle-income countries (LMICs) developed by Bohren et al. was used to frame the current study and link the findings of the study to the body of knowledge.

Results The FGDs included a total of 32 participants. The mean age of the overall sample was 32.6 years (± SD = 5.2). Participants' educational characteristics indicate that the majority (24 out of 32) was found to have no formal education, and two-thirds of participants were found to have one to five children. Three-fourths of them attended the ANC twice and they all gave birth to their last child at home. Two themes emerged from the analysis of focus group data, namely provision of quality, respectful and dignified midwifery care, and lack of awareness about facility delivery. These themes were described as a rich and comprehensive account of the views and suggestions made by focused antenatal care [FANC] participants on measures required to improve the use of the facility-delivery services. The findings of the study raise concerns about the effectiveness of FANC in encouraging facility-deliveries since FANC participants had not used health facilities for their last childbirth. According to the findings of the focus groups, women who took part in this study identified measures required to increase the use of health facility-delivery services among FANC participants in Addis Ababa's slum residents. It is to be expected that diligent counseling during antenatal care about birth plans would facilitate prompt arrival at facilities consistent with the desires of women.

Plain language summary Global strategies for targeting high maternal mortality levels are based on ensuring eligible delivery attendance along with access to obstetric emergency care. Research examining strategies to increase facility-based skilled birth attendance among slum residents in Addis Ababa, Ethiopia, is minimal. The study aimed to examine women's perspectives on measures needed to improve the use of health facility-based delivery services. A qualitative research design, both exploratory and descriptive, was used. Women in the reproductive age group (18–49 years of age) living in the slum areas of Addis Ababa, Ethiopia, participated in the study. The study used a purposeful sampling method. Four audio-recorded focus group discussions [FGDs] were conducted with 32 participants. In FGDs, the number of participants was between 6 and 10 women. Data were analyzed in conjunction with data collection. For the research, thematic analysis was performed. Two issues arose from the review of data from focus group interviews, namely quality care provision, respectful and dignified midwifery care, and lack of awareness about facility delivery. These themes were identified as a detailed and comprehensive account of the views and suggestions of focused antenatal care [FANC] participants on steps needed to enhance the use of health facility-based delivery services. According to the results of the focus groups, among FANC participants in the slum residents of Addis Ababa, women who took part in this study identified steps needed to increase the use of health facility-based delivery services. It is to be expected that diligent counseling during antenatal care about birth plans would facilitate prompt arrival at facilities consistent with the desires of women.