Factors associated with non-institutional births in the Shiselweni region of Swaziland

Abstract

With a lack of human resources, such as skilled birth attendants in developing countries, institutional births must be increased as part of a global strategy to reduce maternal and newborn mortality rates. This study aimed to identify and describe factors associated with non-institutional births in the Shiselweni region of Swaziland in an attempt to provide recommendations to increase institutional births, ultimately reducing maternal and neonatal mortality rates. A quantitative, descriptive and cross-sectional design was employed. Multiple-stage sampling was done, and data were collected from 157 respondents between 14 to 49 years of age, who experienced a non-institutional birth in the year 2019, by means of questionnaires. The Statistical Package for Social Sciences (SPSS) version 23 was used to analyse data. The findings revealed that level of education, being single, unemployed, residing in rural areas, unplanned pregnancies, inadequate antenatal care (ANC) visits, a lack of money for transport and hospital fees, and the unavailability of transport were factors mentioned by respondents as influencing non-institutional births. The challenges reported were vaginal tears, postpartum haemorrhage, stillbirths, urine incontinence, and retained placenta. The non-institutional births were all conducted by unskilled birth attendants using unsterile equipment as the woman lacked emergency delivery kits. It is recommended that transport services for women in labour should be free, infrastructure should be improved, human resources should be adequate, men should be involved in maternal health matters, and women need to be empowered. Motivating institutional births and providing support for women by a skilled birth attendant, such as a midwife or doctor, can contribute to the country reaching the Sustainable Development Goals.