King Rosemary, Jackson Ruth, Dietsch Elaine, Hailemariam Asseffa
Federation University, PO Box 663, Ballarat, Vic. 3353, Australia.
Alfred Deakin Research Institute, Deakin University, Geelong Waterfront Campus, Locked Bag 20000, Geelong, Vic. 3220, Australia.
Midwifery. 2015 May;31(5):540-6. doi: 10.1016/j.midw.2015.02.004. Epub 2015 Feb 12.
to explore barriers and facilitators that enable women to access skilled birth attendance in Afar Region, Ethiopia.
researchers used a Key Informant Research approach (KIR), whereby Health Extension Workers participated in an intensive training workshop and conducted interviews with Afar women in their communities. Data was also collected from health-care workers through questionnaires, interviews and focus groups.
fourteen health extension workers were key informants and interviewers; 33 women and eight other health-care workers with a range of experience in caring for Afar childbearing women provided data as individuals and in focus groups.
participants identified friendly service, female skilled birth attendants (SBA) and the introduction of the ambulance service as facilitators to SBA. There are many barriers to accessing SBA, including women׳s low status and restricted opportunities for decision making, lack of confidence in health-care facilities, long distances, cost, domestic workload, and traditional practices which include a preference for birthing at home with a traditional birth attendant.
many Afar men and women expressed a lack of confidence in the services provided at health-care facilities which impacts on skilled birth attendance utilisation.
ambulance services that are free of charge to women are effective as a means to transfer women to a hospital for emergency care if required and expansion of ambulance services would be a powerful facilitator to increasing institutional birth. Skilled birth attendants working in institutions need to ensure their practice is culturally, physically and emotionally safe if more Afar women are to accept their midwifery care. Adequate equipping and staffing of institutions providing emergency obstetric and newborn care will assist in improving community perceptions of these services. Most importantly, mutual respect and collaboration between traditional birth attendants (Afar women׳s preferred caregiver), health extension workers and skilled birth attendants will help ensure timely consultation and referral and reduce delay for women if they require emergency maternity care.
探讨促使埃塞俄比亚阿法尔地区妇女获得熟练助产服务的障碍和促进因素。
研究人员采用关键信息人研究方法（KIR），即健康推广工作者参加强化培训研讨会，并在社区对阿法尔妇女进行访谈。还通过问卷调查、访谈和焦点小组从医护人员那里收集数据。
14名健康推广工作者是关键信息人和访谈者；33名妇女以及8名其他在照顾阿法尔育龄妇女方面有不同经验的医护人员以个人身份和在焦点小组中提供了数据。
参与者确定友好服务、女性熟练助产士（SBA）以及救护车服务的引入是获得熟练助产服务的促进因素。获得熟练助产服务存在许多障碍，包括妇女地位低下和决策机会有限、对医疗机构缺乏信心、路途遥远、费用、家务负担以及传统习俗，其中包括倾向于在家由传统助产士接生。
许多阿法尔男女对医疗机构提供的服务缺乏信心，这影响了熟练助产服务的利用率。
对妇女免费的救护车服务在必要时将妇女转运至医院进行急诊护理方面是有效的，扩大救护车服务将有力促进机构分娩率的提高。如果要有更多阿法尔妇女接受助产护理，在机构工作的熟练助产士需要确保其做法在文化、身体和情感方面都是安全的。为提供紧急产科和新生儿护理的机构配备足够的设备和人员将有助于改善社区对这些服务的看法。最重要的是，传统助产士（阿法尔妇女首选的护理人员）、健康推广工作者和熟练助产士之间的相互尊重与合作将有助于确保及时咨询和转诊，并减少妇女在需要紧急产科护理时的延误。
