Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway.
Institute of Health and Society, Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway.
Glob Health Action. 2022 Dec 31;15(1):2040149. doi: 10.1080/16549716.2022.2040149.
Determinants for women's care seeking for birth in low-income setting are multifactorial and remain poorly understood. A life course approach can assist to structure the interplay of the different factors that lead to women seeking care or not.
In this study we aimed to explore individual women's reproductive pathways, and increase understanding of how important life events including previous pregnancy and birth experiences can help us to understand individual choices made for care seeking during childbirth.
The study took place in Tanzania between 2015 and 2017. 14 women were followed throughout their pregnancy, birth and postpartum period through participant observation and in-depth interviews. In total 94 in-depth interviews were held (between 5-7 interviews per woman). Analysis occurred continuous throughout the data collection period resulting in detailed narratives of crucial events across women's life course, with specific attention to their current pregnancy.
Of the 14 women, seven had a facility birth, six a home birth and one woman gave birth at the home of a local birth attendant. Four different story plots were identified: expected home birth, expected facility birth, unexpected facility birth and unexpected home birth. Birth narratives of four women representative of the different story plots are presented. Narratives illustrate women's individual reproductive pathways including the various factors influencing women's expectations and justifications for their actions during their pregnancy and birth.
Women's agency, including women's perception of self, the self in relation to the social environment and reflection on risks associated with the range of options, influences the final decision made for birth. Women's narratives suggest that quality of care can function as a primary pull factor for facility birth. As long as home birth is by some perceived to be a better alternative, achieving skilled care for all will be difficult to achieve.
在低收入环境中，女性寻求分娩护理的决定因素是多方面的，目前仍了解不足。生命历程方法可以帮助构建导致女性寻求或不寻求护理的不同因素之间的相互作用。
在这项研究中，我们旨在探讨个体女性的生殖途径，并增加对重要生命事件（包括以前的妊娠和分娩经历）如何帮助我们理解个体在分娩时寻求护理的选择的理解。
该研究于 2015 年至 2017 年在坦桑尼亚进行。通过参与观察和深入访谈，14 名女性在整个妊娠、分娩和产后期间接受了跟踪。总共进行了 94 次深入访谈（每位女性 5-7 次访谈）。分析在数据收集期间持续进行，导致了女性生命历程中关键事件的详细叙述，特别关注她们当前的妊娠。
在 14 名女性中，有 7 人在医疗机构分娩，6 人在家分娩，1 人在当地分娩助手的家中分娩。确定了四个不同的故事情节：预期的家庭分娩、预期的医疗机构分娩、意外的医疗机构分娩和意外的家庭分娩。呈现了代表不同故事情节的四名女性的分娩叙述。叙述说明了女性的个体生殖途径，包括影响女性在妊娠和分娩期间期望和行动的各种因素。
女性的能动性，包括女性对自我的认知、自我与社会环境的关系以及对与各种选择相关的风险的思考，影响了最终的分娩决策。女性的叙述表明，护理质量可以作为医疗机构分娩的主要吸引力因素。只要家庭分娩被认为是一个更好的选择，就很难实现所有产妇都能获得熟练护理的目标。
