Factors Determining the Choice of Health Care Facilities by Pregnant Women
CHAPTER ONE
Objective of the study
This study aims to systematically explore the differences and the factors that influence women’s preferences for places to give birth in Addis Ababa. Specifically it aims:
- To determine the Socioeconomic and Demographic Characteristics of the pregnant women.
- To examine the determinants of choice of healthcare facilities by pregnant women.
CHAPTER TWO
LITERATURE REVIEW
Introduction
This chapter focused on literature related to the factors influencing women’s choice of place of delivery. Demographic factors, social and economic factors in determining women’s choice of place of delivery will be analyzed. One theory has been presented to support the study. A conceptual framework that diagrammatically links variables (that is, independent, dependent and intervening) illustrated and in depth explanation of the variables is provided. Knowledge gap in the literature reviewed has also been identified.
Decision Making Process
People make decisions about many things. They make political decisions; personal decisions, including medical choices, romantic decisions, and career decisions; and financial decisions, which may also include some of the other kinds of decisions and judgments. Quite often, the decision making process is fairly specific to the decision being made. Some choices are simple and seem straight forward, while others are complex and require a multistep approach to making the decisions (Dietrich, 2010).
Therefore, choice of place of delivery by women who are expectant could be influenced by so many factors which may include their age, number of children they have, marital status, level of education, traditional beliefs, occupation, means of transport, antenatal care visits, knowledge and attitudes towards quality of care in health facilities among others. These factors may influence their behavior regarding where to give birth, that is, health facility, home or at traditional birth attendant.
CHAPTER THREE
RESEARCH DESIGN AND METHODS
Study Area
Addis Ababa, the study area, is divided into 10 subcities and each subcity is further divided into several small administrative units called Kebeles. In the 2007 Ethiopia Housing and Population Census, Kebeles were further subdivided into enumeration areas (EAs). An EA is a geographic area consisting of a convenient number of dwelling units which was used as a counting unit for the census.
Population
The average number of households (HHs) per EA in urban Ethiopia is 169. The number of clusters (EAs) in Addis Ababa was about 3865.
Because of the different levels of political or administrative structures and wider geographic areas.
CHAPTER FOUR
PRESENTATION OF RESULT AND ANALYSIS
Introduction
In this study, the data collection response rate was 99.4%, 901 out of 906. Women were asked about their place of ANC follow-up and places of delivery during their last birth. The inquiry was about where the majority of the ANC visits occurred as there could be possibility of shifting from one place of care to another during the same pregnancy period.
Disparities by Socioeconomic and Demographic Characteristics of Respondents
More than two-thirds (69.2%) and slightly less than a quarter (24.0%) of all the study participants gave birth at public and private healthcare facilities, respectively. About 6.8% of them delivered at home. Both slum and non-slum residents accessed ANC mainly at public healthcare facilities. More than three-fourths of slum resident women gave birth at public healthcare facilities compared to slightly more than half of the non-slum residents. Higher proportion of the non-slum residents (41.7%) gave birth at private facilities compared to only 15.3% of the slum residents.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATION
Conclusion
Despite the high number of ANC attendances among mothers in the study area, a notable number of pregnant women especially among slum residents still chose to deliver at home. While women’s perception of the private sector in Addis Ababa is that it offers better quality services than that offered in the public facilities, still most respondents preferred to deliver in public healthcare institutions despite the general doubts about the quality of services delivered. The preferences were attributed to short distance and perceived as well as experienced low cost of care at public facilities. The observation that utilisation of health facilities was high among younger age groups compared to older women was interesting and factors that demotivate older women from utilising health facilities need to be studied further. To prevent women from reverting back to home delivery, effective communication and particularly counselling of women during ANC visits about the danger signs and complications of pregnancy and childbirth should be enhanced, and concerted effort should be made to encourage every pregnant woman to attend ANC services. Efforts should be directed at the healthcare facilities so that they should provide quality ANC services.
In interpreting this study’s findings, it is advisable to consider some of the limitations of the study. The cross sectional nature of the data does not allow making causal inferences about the relationship between delivery care and the risk factors. It is important to keep in mind that the analysed data includes information reported by mothers only from last pregnancies or child births. This study did not collect data about the views and practices of service providers related to quality of services. The study was also limited to the capital city and findings might not reflect the situation of the rest of the country.
Recommendations
The following recommendations may help women in Addis Ababa and Ethiopia at large to make a better choice when the time to give birth reaches.
Demographic factors
Advocacy to all women of child bearing age on importance of hospital deliveries, this can be done by the Ministry of Health, Ngo’s and community based organizations. Mothers should be made aware that each pregnancy has its own challenges having delivered before does not put them out of risk.
Social factors
Involvement of husbands as key decision makers in the choice of place of delivery during antenatal clinic visits could be one of the best strategies in reduction of home deliveries.
Economic factors
The government should focus more on women empowerment through creating entrepreneurship opportunities for them as a measure to make them financially stable and this could of a positive impact on the choices they make during delivery.
Antenatal clinic attendance
During antenatal clinic visits health workers should emphasize more on issues like early signs of labour, birth preparedness and expected dates of delivery as a step to reduce home deliveries. They should also encourage mothers to be accompanied by their husbands during these visits.
Health workers should increase the coverage of antenatal care by reaching out to women at the community level through outreach programmes that are geared towards creating awareness that antenatal clinic visits are important for them when they are expectant.
References
- Federal Ministry of Health, “Health sector development program IV 2010/11–2014/15,” Final Draft, Federal Democratic Republic of Ethiopia, Addis Ababa, Ethiopia, 2010.
- Central Statistical Agency and Inner City Fund International (CSA and ICF International), Ethiopia Demographic and Health Survey 2011, Central Statistical Agency, Addis Ababa, Ethiopia; ICF International, Calverton, Md, USA, 2012.
- Balabanova, A. Mills, L. Conteh et al., “Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening,” The Lancet, vol. 381, no. 9883, pp. 2118–2133, 2013.
- Federal Ministry of Health, National Reproductive Health Strategy 2006–2015, Federal Ministry of Health, Addis Ababa, Ethiopia, 2006.
- B. Etowa, “Becoming a mother: the meaning of childbirth for African-Canadian women,” Contemporary Nurse, vol. 41, no. 1, pp. 28–40, 2012.
- S. R. Murthy, P. V. Murthy, M. Hari, V. K. R. Kumar, and K. Rajasekhar, “Place of birth: why urban women still prefer home deliveries?” Journal of Human Ecology, vol. 21, no. 2, pp. 149–154, 2007.
- Singh, L. Remez, U. Ram, A. M. Moore, and S. Audam, Barriers to Safe Motherhood in India, Guttmacher Institute, New York, NY, USA, 2009.
- Federal Ministry of Health, Health and Health Related Indicators 2011, Policy Planning Directorate, Addis Ababa, Ethiopia, 2011.
- Andersen and J. F. Newman, “Societal and individual determinants of medical care utilization in the United States,” The Milbank Quarterly, vol. 83, no. 4, pp. 1–28, 2005.
