Institute for Global Health, University College London , London, UK.
Department of Population Health, London School of Hygiene and Tropical Medicine , London, UK.
Glob Health Action. 2020 Dec 31;13(1):1785735. doi: 10.1080/16549716.2020.1785735.
Nigeria has one of the highest maternal mortality rates in the world, but facility delivery levels are relatively low and stagnant. Few qualitative studies have explored this issue and most have focused on barriers to utilization, much can be learnt from women who already deliver in facilities.
We aimed to identify facilitators and barriers to facility delivery in Gombe State in North East Nigeria with a focus on women who have had a facility delivery.
We conducted 24 narrative and in-depth interviews with mothers, and 16 focus-group-discussions with mothers, fathers, grandmothers and community health workers. Data were collected in Hausa, and transcribed and translated into English. Preliminary data analysis was conducted through team workshops, followed by systematic coding of the transcripts. Initial themes were identified a priori from the research questions and others emerged during coding.
A safe delivery was the main motivator for facility delivery, with facilities considered safe because of the presence of a trained health worker, the detection and management of problems, the availability of medicines and good hygiene. Those who delivered in a facility had a desire to be modern and rejected traditional practices. Decision-making power, social norms, accessibility, cost and perceived poor quality of care were reported as barriers. Community health workers, when they reached households, provided information on the benefits of facility delivery, stressed that times were changing, provided practical help such as arranging transport and, by accompanying families to the facility, brokered better quality of care and provided social support.
This study highlights both the facilitators and barriers to facility delivery, and demonstrates the need for interventions to address a wide range of issues at multiple levels.
尼日利亚是世界上孕产妇死亡率最高的国家之一，但分娩设施的使用率相对较低且停滞不前。很少有定性研究探讨过这个问题，而且大多数研究都集中在利用障碍上，我们可以从已经在医疗机构分娩的女性身上学到很多东西。
我们旨在确定尼日利亚东北部贡贝州的医疗机构分娩的促进因素和障碍，重点关注已经在医疗机构分娩的女性。
我们对母亲进行了 24 次叙事性和深入访谈，并对母亲、父亲、祖母和社区卫生工作者进行了 16 次焦点小组讨论。数据以豪萨语收集，并转录为英文。初步数据分析是通过团队研讨会进行的，然后对转录本进行系统编码。初步主题是根据研究问题预先确定的，其他主题则是在编码过程中出现的。
安全分娩是选择医疗机构分娩的主要动机，因为有经过培训的卫生工作者、能够发现和处理问题、提供药物和良好的卫生条件，所以医疗机构被认为是安全的。那些在医疗机构分娩的人希望现代化，拒绝传统做法。决策权、社会规范、可及性、费用和被认为护理质量差被报告为障碍。社区卫生工作者在入户时提供有关医疗机构分娩益处的信息，强调时代在变化，提供实际帮助，如安排交通，并通过陪同家庭到医疗机构，促成更好的护理质量并提供社会支持。
本研究强调了医疗机构分娩的促进因素和障碍，并表明需要采取干预措施，在多个层面解决各种问题。
