Jacobs Choolwe, Michelo Charles, Hyder Adnan
School of Public Health, University of Zambia, Lusaka, Zambia.
Harvest Research Institutes, Harvest University, Lusaka, Zambia.
Front Glob Womens Health. 2023 Jan 6;3:916826. doi: 10.3389/fgwh.2022.916826. eCollection 2022.
Significant proportions of women living in urban areas including the capital cities continue to deliver at home. We aimed to understand why mothers in a selected densely populated community of Lusaka city in Zambia deliver from home without assistance from a skilled provider during childbirth.
Using a phenomenological case study design, we conducted Focus Group Discussions and In-depth Interviews with mothers who delivered at home without assistance from a skilled provider. The study was conducted between November 2020 and January 2021 among 19 participants. Data were analysed using content analysis.
Individual-related factors including the belief that childbirth is a natural and easy process that did not require assistance, lack of transport to get to the health facility, influence and preference for care from older women who were perceived to have the experience and better care, failure to afford baby supplies, and waiting for partner to provide the supplies that were required at the health facility influenced mothers' choices to seek care from skilled providers. Health system-related factors included mistreatment and disrespectful care such as verbal and physical abuse by skilled healthcare providers, stigma and discrimination, institutional fines, and guidelines such as need to attend antenatal care with a spouse and need to provide health facility demanded supplies.
Individual and health system access related factors largely drive the choice to involve skilled providers during childbirth. The socioeconomic position particularly contributes to limited decision-making autonomy of mothers, thus, creating challenges to accessing care in health facilities. The health system-related factors found in this study such as mistreatment and disrespectful care suggests the need for redesigning effective and sustainable urban resource-limited context maternal health strategies that are culturally acceptable, non-discriminatory, and locally responsive and inclusive. Rethinking these strategies this way has the potential to strengthening equitable responsive health systems that could accelerate attainment of sustainable developmental goal (SDG) 3 targets.
包括首都城市在内的城市地区，仍有相当比例的妇女在家中分娩。我们旨在了解赞比亚卢萨卡市一个选定的人口密集社区中，为何母亲们在分娩时未获得熟练医护人员的协助就在家中分娩。
采用现象学案例研究设计，我们对未获得熟练医护人员协助就在家中分娩的母亲进行了焦点小组讨论和深入访谈。该研究于2020年11月至2021年1月期间对19名参与者开展。数据采用内容分析法进行分析。
与个人相关的因素包括：认为分娩是一个自然且轻松的过程，无需协助；缺乏前往医疗机构的交通工具；受被认为有经验且能提供更好护理的老年女性的影响和照顾偏好；无力购买婴儿用品；等待伴侣提供医疗机构所需用品等，这些因素影响了母亲们寻求熟练医护人员护理的选择。与卫生系统相关的因素包括虐待和不尊重的护理，如熟练医护人员的言语和身体虐待、污名化和歧视、机构罚款，以及诸如需要配偶陪同进行产前护理和需要提供医疗机构要求的用品等规定。
个人因素和与卫生系统可及性相关的因素在很大程度上推动了分娩时是否寻求熟练医护人员协助的选择。社会经济地位尤其导致母亲的决策自主权有限，从而给在医疗机构获得护理带来挑战。本研究中发现的与卫生系统相关的因素，如虐待和不尊重的护理，表明需要重新设计有效且可持续的、适用于城市资源有限环境的孕产妇健康策略，这些策略应在文化上可接受、无歧视、对当地情况有响应且具有包容性。以这种方式重新思考这些策略有可能加强公平响应性的卫生系统，从而加速实现可持续发展目标3的各项指标。
