Nepal Public Health Foundation, Kathmandu, Nepal.
Center for International Health, Ludwig-Maximilians-University, Munich, Germany.
Reprod Health. 2018 Jun 20;15(1):110. doi: 10.1186/s12978-018-0553-0.
Giving birth assisted by skilled care in a health facility plays a vital role in preventing maternal deaths. In Nepal, delivery services are free and a cash incentive is provided to women giving birth at a health facility. Nevertheless, about half of women still deliver at home. This study explores socio-cultural and health service-related barriers to and facilitators of institutional delivery.
Six village development committees in hill and plain areas were selected in Chitwan district. We conducted a total of 10 focus group discussions and 12 in-depth-interviews with relevant stakeholder groups, including mothers, husbands, mothers-in-law, traditional birth attendants, female community health volunteers, health service providers and district health managers. Data were analyzed inductively using thematic analysis.
Three main themes played a role in deciding the place of delivery, i.e. socio-cultural norms and values; access to birthing facilities; and perceptions regarding the quality of health services. Factors encouraging an institutional delivery included complications during labour, supportive husbands and mothers-in-law, the availability of an ambulance, having birthing centres nearby, locally sufficient financial incentives and/or material incentives, the 24-h availability of midwives and friendly health service providers. Socio-cultural barriers to institutional deliveries were deeply held beliefs about childbirth being a normal life event, the wish to be cared for by family members, greater freedom of movement at home, a warm environment, the possibility to obtain appropriate "hot" foods, and shyness of young women and their position in the family hierarchy. Accessibility and quality of health services also presented barriers, including lack of road and transportation, insufficient financial incentives, poor infrastructure and equipment at birthing centres and the young age and perceived incompetence of midwives.
Despite much progress in recent years, this study revealed some important barriers to the utilization of health services. It suggests that a combination of upgrading birthing centres and strengthening the competencies of health personnel while embracing and addressing deeply rooted family values and traditions can improve existing programmes and further increase institutional delivery rates.
在医疗机构中由熟练护理人员协助分娩，对预防产妇死亡至关重要。在尼泊尔，分娩服务是免费的，并向在医疗机构分娩的妇女提供现金奖励。然而，仍有约一半的妇女在家中分娩。本研究探讨了影响产妇选择在医疗机构分娩的社会文化和卫生服务相关障碍和促进因素。
在奇特旺地区选择了山区和平原地区的 6 个村发展委员会。我们总共与相关利益相关者群体（包括母亲、丈夫、婆婆、传统助产妇、女性社区卫生志愿者、卫生服务提供者和地区卫生管理人员）进行了 10 次焦点小组讨论和 12 次深入访谈。使用主题分析对数据进行了归纳分析。
有三个主要主题对分娩地点的选择起作用，即社会文化规范和价值观；获得分娩设施的途径；以及对卫生服务质量的看法。鼓励在医疗机构分娩的因素包括分娩过程中的并发症、支持的丈夫和婆婆、救护车的可用性、附近有分娩中心、当地有足够的经济激励和/或物质激励、助产士 24 小时可及以及友好的卫生服务提供者。在医疗机构分娩的社会文化障碍是对分娩是正常生命事件的根深蒂固的信念、希望得到家庭成员的照顾、在家中更大的行动自由、温暖的环境、获得适当的“热”食物的可能性以及年轻女性的羞怯及其在家庭中的地位。卫生服务的可及性和质量也是障碍，包括道路和交通不便、经济激励不足、分娩中心基础设施和设备差以及助产士年龄较轻且能力被认为不足。
尽管近年来取得了很大进展，但本研究揭示了利用卫生服务的一些重要障碍。这表明，在提升分娩中心和加强卫生人员能力的同时，接受和解决根深蒂固的家庭价值观和传统，可以改善现有方案，并进一步提高在医疗机构分娩的比例。
