Melberg Andrea, Diallo Abdoulaye Hama, Ruano Ana Lorena, Tylleskär Thorkild, Moland Karen Marie
Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Centre MURAZ, Ministère de la Santé, Bobo-Dioulasso, Burkina Faso.
PLoS One. 2016 Jun 3;11(6):e0156503. doi: 10.1371/journal.pone.0156503. eCollection 2016.
The policy of institutional delivery has been the cornerstone of actions aimed at monitoring and achieving MDG 5. Efforts to increase institutional births have been implemented worldwide within different cultural and health systems settings. This paper explores how communities in rural Burkina Faso perceive the promotion and delivery of facility pregnancy and birth care, and how this promotion influences health-seeking behaviour. A qualitative study was conducted in South-Western Burkina Faso between September 2011 and January 2012. A total of 21 in-depth interviews and 8 focus group discussions with women who had given birth recently and community members were conducted. The data were analyzed using qualitative content analysis and interpreted through Merton's concept of unintended consequences of purposive social action. The study found that community members experienced a strong pressure to give birth in a health facility and perceived health workers to define institutional birth as the only acceptable option. Women and their families experienced verbal, economic and administrative sanctions if they did not attend services and adhered to health worker recommendations, and reported that they felt incapable of questioning health workers' knowledge and practices. Women who for social and economic reasons had limited access to health facilities found that the sanctions came with increased cost for health services, led to social stigma and acted as additional barriers to seek skilled care at birth. The study demonstrates how the global and national policy of skilled pregnancy and birth care can occur in unintentional ways in local settings. The promotion of institutional care during pregnancy and at birth in the study area compromised health system trust and equal access to care. The pressure to use facility care and the sanctions experienced by women not complying may further marginalize women with poor access to facility care and contribute to worsened health outcomes.
机构分娩政策一直是旨在监测和实现千年发展目标5的行动基石。在全球范围内，不同文化和卫生系统背景下都在努力增加机构分娩率。本文探讨布基纳法索农村社区如何看待设施内孕期和分娩护理的推广，以及这种推广如何影响就医行为。2011年9月至2012年1月期间在布基纳法索西南部进行了一项定性研究。对近期分娩的妇女和社区成员共进行了21次深入访谈和8次焦点小组讨论。使用定性内容分析法对数据进行分析，并通过默顿的目的性社会行动意外后果概念进行解读。研究发现，社区成员感受到在医疗机构分娩的巨大压力，并认为卫生工作者将机构分娩定义为唯一可接受的选择。如果妇女及其家人不参加服务或不遵守卫生工作者的建议，他们会受到言语、经济和行政制裁，并且报告称他们觉得无法质疑卫生工作者的知识和做法。因社会和经济原因难以获得卫生设施服务的妇女发现，制裁伴随着卫生服务成本的增加，导致社会污名化，并成为分娩时寻求专业护理的额外障碍。该研究表明，全球和国家的专业孕期和分娩护理政策在当地环境中可能以意想不到的方式出现。研究地区孕期和分娩期间对机构护理的推广损害了卫生系统的信任和平等获得护理的机会。使用机构护理的压力以及未遵守规定的妇女所面临的制裁可能会进一步边缘化那些难以获得机构护理服务的妇女，并导致健康结果恶化。
