Women's Lived Experiences of Giving Birth in Ghana: A Metasynthesis of the Literature

BACKGROUNDThe purpose of this metasynthesis is to analyze women's lived experiences of giving birth in Ghana during and after the Millennium Development Goals (MDGs), when health policy in Ghana was changed to urge women to birth in health services with skilled attendants.METHODAn interpretive phenomenological framework guided the review of the literature. Three electronic databases were searched as well as reference lists and author searches. Articles that met the screening criteria for inclusion were coded and thematically analyzed, then drawn together to construct the essence of women's experiences of giving birth in Ghana.RESULTSSeven themes were constructed from the data and these were poor quality health services, maltreatment by midwives, mixed emotions about pregnancy and childbirth, supernatural fears, women wanting safe births with skilled birth attendants, uncertainty about reaching a health facility, and decision-making hierarchy. There were three counter themes and these were women wanting a home birth with a traditional midwife, defiance against dominant decision-makers by some women, and a belief that “not all nurses are bad.”CONCLUSIONGhanaian women have heeded the MDGs and health policy messages to birth with skilled attendants, but in reality, they are not always accessible, available, appropriate, or of high quality. Maternal health services still need much improvement including more resources such as staff, essential services, medicines, and quality assurance standards.

Factors associated with skilled attendants at birth among married adolescent girls in Nigeria: evidence from the Multiple Indicator Cluster Survey, 2016/2017

BackgroundThis study examines the factors associated with skilled birth attendants at delivery among married adolescent girls in Nigeria.MethodsThe study was a secondary data analysis of the fifth round of the Multiple Indicator Cluster Survey conducted between September 2016 and January 2017. Married adolescent girls aged 15–19 y who had live births in the last 2 y preceding the survey were included in the analysis. We performed univariate and multivariate logistic regression analyses with a skilled birth attendant (doctor, nurse or midwife) at delivery as the outcome variable and sociodemographic, male partner- and maternal health-related factors as explanatory variables.ResultsOf the 789 married adolescent girls, 387 (27% [95% CI=22.8–30.7]) had a skilled birth attendant at delivery. In the adjusted model, adolescent girls who were aged ≥18 y (ref: <18 y), primiparous (ref: multiparous), had antenatal care (ANC) provided by skilled healthcare providers (ref: no ANC), belonged to at least the poor and middle wealth index quintiles (ref: poorest), and resided in the south west zone (ref: north central), independently had a significantly higher likelihood of having a skilled birth attendant at delivery.ConclusionsInterventions that will reduce pregnancy in younger adolescent girls, poverty, and increase ANC provided by skilled attendants, are likely to improve deliveries assisted by skilled birth attendants among married adolescent girls in Nigeria.

Birth attendance in rural Bangladesh: practices and correlates

IntroductionThe maternal mortality ratio (MMR) and neonatal mortality rate (NMR) are higher in the rural regions of Bangladesh compared to the urban areas or the national average. These two rates could be reduced by increasing use of skilled birth attendance in rural regions of this country. Although the majority of Bangladeshi population lives in rural areas, there has been a little investigation of the practices and determinants of delivery attendance in this region of Bangladesh. This study investigated the practices and determinants of attendance during child-births in rural Bangladesh.MethodsData were collected by the 2014 Bangladesh Demographic and Health Survey (BDHS 2014). After reporting the distribution of deliveries by types of attendance and distribution of selected factors, logistic regression was applied to calculate the crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs), and p-values.ResultsMore than half of the deliveries (53.1%) were conducted by traditional attendants; community skilled attendants were present in only a small number of deliveries. The following factors were positively associated with deliveries by skilled attendants: 25-34 years age group of women (adjusted odds ratio (AOR): 1.4; 95% CI: 1.1-1.8), a higher education level of women (AOR: 2.9; 95% CI: 1.7-4.9), or their husbands (AOR: 2.4; 95% CI: 1.6-3.7), receiving antenatal care (AOR: 2.1; 95% CI: 1.6-2.7), and higher wealth quintiles (AOR of the richest wealth quintile vs the poorest: 3.5; 95% CI: 2.3-5.3). On the other hand, women having a higher parity (i.e., number of pregnancy, ≥2) led to a lower likelihood of delivery by skilled birth attendants. The proportion of deliveries attended by skilled attendants was significantly lower in the other six divisions compared to Khulna.ConclusionsSocioeconomic factors should be considered to design future interventions to increase the proportion of deliveries attended by skilled delivery attendants. Awareness programs are required in rural areas to highlight the importance of skilled attendants. Further re-evaluation of the community skilled birth attendants program is required.

Protocol for a scoping review to identify and map the global health personnel considered skilled attendants at birth in low and middle-income countries between 2000 and 2015

IntroductionDespite progress towards the Millennium Development Goals (MDG), maternal mortality remains high in countries where there are shortages of skilled personnel able to manage and provide quality care during pregnancy and childbirth. The ‘percentage of births attended by skilled health personnel’ (SAB, skilled attendants at birth) was a key indicator for tracking progress since the MDGs and is part of the Sustainable Development Goal agenda. However, due to contextual differences between and within countries on the definition of SAB, a lack of clarity exists around the training, competencies, and skills they are qualified to perform. In this paper, we outline a scoping review protocol that poses to identify and map the health personnel considered SAB in low and middle-income countries (LMIC).Methods and analysisA search will be conducted for the years 2000–2015 in PubMed/MEDLINE, EMBASE, CINAHL Complete, Cochrane Database of Systematic Reviews, POPLINE and the WHO Global Health Library. A manual search of reference lists from identified studies or systematic reviews and a hand search of the literature from international partner organisations will be done. Original studies conducted in LMIC that assessed health personnel (paid or voluntary) providing interventions during the intrapartum period will be considered for inclusion.Ethics and disseminationA scoping review is a secondary analysis of published literature and does not require ethics approval. This scoping review proposes to synthesise data on the training, competency and skills of identified SAB and expands on other efforts to describe this global health workforce. The results will inform recommendations around improved coverage measurement and reporting of SAB moving forward, allowing for more accurate, consistent and timely data able to guide decisions and action around planning and implementation of maternal and newborn health programme globally. Data will be disseminated through a peer-reviewed manuscript, conferences and to key stakeholders within international organisations.

Factors Influencing Patronage of Supervised Delivery Among Parturients in Moriki of Zamfara, Nigeria

Women in Moriki delivered at home without skilled attendants. The study was to identify the factors influencing patronage of supervised delivery among women who had given birth in Moriki, Nigeria. A quantitative, cross-sectional design was used. A sample of 350 women was recruited using a multistage sampling technique. Structured questionnaires were administered. The 342 completed questionnaires were analyzed using SPSS Version 20. Women who were younger, educated, have few children, earning higher income, and whose husbands were educated were more likely to patronize supervised delivery. Therefore, midwives should liaise with the other health workers to design a program targeting women with high parity, uneducated women, and older women informing them about the relevance of supervised delivery.

The Bangladesh Midwifery Programme – a giant step towards Safe Motherhood

Safe Motherhood is not only a Reproductive Right but also a basic human right. Provision of Safe Motherhood services like skilled attendants at birth reduces maternal deaths and morbidities. Bangladesh has reduced maternal deaths from 540/ 100,000 live births in the nineties to 194 in 2010. In a recent estimate by WHO, UNICEF, UNFPA, the World Bank and the United Nations Population Division, the Maternal Mortality Rate (MMR) has declined to 170 per 100,000 live births in Bangladesh.DOI: http://dx.doi.org/10.3329/bioethics.v5i3.21535 Bangladesh Journal of Bioethics 2014; 5(3):26-27