Preference of homebirth and associated factors among pregnant women in Arba Minch health and demographic surveillance site, Southern Ethiopia

PLoS ONE, Volume 17, No. 10 October, Year 2022

Interpretation

Background Home birth preference is the need of pregnant women to give birth at their home with the help of traditional (unskilled) birth attendants. Homebirth with unskilled birth attendants during childbirth is the main leading indicator for maternal and newborn death. In Ethiopia, numbers of women prefer homebirth which is assisted by unskilled personal. However, there is no information regarding the problem in the Arba Minch zuria woreda. Therefore, it is important to identify prevalence of preference of homebirth and associated factors. Objectives This study aimed to assess the preference of home birth and associated factors among pregnant women in Arba Minch health and demographic surveillance site. Method and materials A community-based cross-sectional study was conducted among pregnant women in Arba Minch health and demographic surveillance site, from May 1 to June 1, 2021. Using simple random sampling technique, 416 study samples were selected. Data were collected by interviewer-administered questionnaire. Data were coded and entered into Epi-Data version 4.4.2.1 computer software and exported to Statistical Package for Social Sciences software version 25 for analysis. Bi-variable binary logistic regression for the selection of potential candidate variables at p-value < 0.25 for multivariable analysis and multivariable binary logistic regression to identify the association between homebirth preference and independent variables were carried out. The level of statistical significance was declared at a p-value < 0.05. Result In this study, in Arba Minch demographic health surveillance site, the prevalence of preference of pregnant women to give birth at their home was 24% [95%CI: (19.9%-28.2%)] The factors significantly associated with the preference of home birth were husband involvement in decision making [AOR: 0.14 (0.05–0.38)], no access of road for transportation [AOR: 2.4 (1.2–5.18)], not heard about the benefit of institutional birth [AOR: 5.3 (2.3–12.2)], poor knowledge about danger signs [AOR: 3 (1.16–7.6)], negative attitude toward services [AOR: 3.1 (1.19–8.02)], and high fear to give birth at institution [AOR: 5.12 (2.4–10.91)]. Conclusions In Arba Minch demographic health surveillance site, the prevalence of preference of pregnant women to give birth at their home was 24%. Husband involvement in decision making, no access of road for transportation, not heard about the benefit of institutional birth, poor knowledge about danger signs, negative attitude toward services, and high fear to give birth at health institutions were factors significantly associated with the preference of home birth. A community-based cross-sectional study was conducted in Arba Minch Health and Demographic Surveillance Site. Arba Minch Health and Demographic Surveillance Site are located in Arba Minch Zuria and Gacho Baba districts, Gamo Zone, Southern Ethiopia, 500 km to the South of Addis Ababa, the capital city of Ethiopia. Arba Minch Zuria district and Gacho Baba district had a total of 31 kebeles [smallest administrative units] and it is included under Arba Minch Zuria Demographic and Health Development Program (AM-DHDP). AM-DHDP is owned by Arba Minch University and it is one of the six public universities Health and Demographic Surveillance System (HDSS) in Ethiopia. The surveillance site consists of nine kebeles which were selected in the representation of 31 kebeles in the district. From them, 6 kebeles were found in Arba Minch zuria district, and the rest three were found in Gacho baba districts. Farming is the predominant occupation of residents in the districts. Based on the 2007 census projection, the districts had a total population of 164,529. The district has 7 health centers and 37 health posts [15]. Around 81.8% of women gave birth at home in Arba Minch Zuria district [16]. Data were collected from May 1- June 1, 2021 from randomly selected pregnant women of Arba Minch zuria woreda. Pregnant women living in selected nine Kebeles of Arba Minch health and demographic surveillance site were study population for this study. Pregnant women living in Arba Minch health and demographic surveillance site included in the study. Pregnant women with severely illness as well as those who were in labor during data collection period were excluded. The sample size was determined by using a single population proportion formula, by considering the following assumptions; taking a proportion of home birth preference conducted in Simada district Ahmara region, Ethiopia, 56.4% proportion, 95% confidence level and power 80 considering 10% non-response rates [11]. Where; n = the desired sample size. Zα/2 = Standard normal deviate of 1.96 which corresponds to 95% confidence level (z value at Alpha = 0.05). P = Proportion of home birth (56.4%). d = an absolute precision (margin of error0 which is 5%. Hence study was conducted in Arba Minch health and demographic surveillance site registration and identification of the women becoming pregnant with their address is one of the core and continuum activities of the health extension workers assigned to the woreda. Since study was conducted in Arba Minch health and demographic surveillance site, the list of pregnant women was obtained from health extension workers working in Arba Minch health and demographic surveillance site. The total number of pregnant women obtained from health extension workers from nine kebeles of Arba Minch health and demographic surveillance site were 610. Before the selection of study participants, proportions to size allocations to each kebele were done. From the list, the required sample size (416) was selected by simple random sampling using computer-generated numbers from each kebele as per the proportions to size allocation to each kebele. The data were collected by using structured interviewer-administered questionnaire. The questionnaires contain questions about socio-demographic characteristics, service-related, obstetrical characteristics, knowledge on danger signs, attitude toward skilled birth services, and fear of childbirth at a health institution. These questionnaires were adapted and developed from published related literatures [11, 12, 17–20]. Nine Health and demographic surveillance site data collectors and three supervisors were used. The data were collected using interviewer-administered questionnaire with participants at their homes. Preference of homebirth was obtained from the question asked to pregnant women; “where do you prefer to give birth?” Response to this question was either of home birth or health facility [hospital, health Centre/clinic, health post, and private hospital/clinic] [11]. To assure the data quality the questionnaires were translated from English to Amharic and retranslated to English for a consistent and proper check. The pre-test was done on a sample of 21 pregnant women (5% of sample size) in Mirab Abaya woreda southern part of Ethiopia. The internal consistency of the tool was assessed by a reliability test (Cronbach’s alpha). The values of Cronbach’s alpha were 0.743, 0.841, and 0.919 for knowledge, attitude, and fear of childbirth at institution questions respectively. Two days of training on data collection procedures, and the objectives of the study for data collectors and supervisors were provided. Collected data was checked for completeness on daily basis by data collectors and supervisors. Dependent variable. Preference of home birth. “Preference of home birth” was the dependent variable and was obtained from the question, “Where do you prefer/need to give birth [choices]?” Response to this question was prefer/need to give birth at home or at government hospital/health center or private hospital/clinic. It was then dichotomized to into prefer health facility birth = 0 and prefer home birth = 1 where respondent’s preference/need to give birth at home “prefer home birth” and all the other categories were grouped as “prefer health facility birth” [11]. Independent variables. The independent variables considered in this study were age of the women, marital status, ethnicity, religion, women educational status, women occupation, husband educational status, husband occupation, household income, residence, family size, Gravid, pregnancy desire, last place of delivery, last mode of delivery, last birth complication, current ANC status, number of ANC follow up, birth interval, distance from health services/facility, road access for transportation to health institutions, information on the benefit of institutional birth, Knowledge of danger signs, attitude toward skilled birth services, decision-making, and fear of childbirth at the institution. Operational definitions. Women’s fear of childbirth at health institution: A total of 13 items were presented to assess fear of childbirth at the health institution. Women responded to their level of fear for each item by a 4-point Likert scale. The women were classified as high fear if they scored mean value and above, and low fear if they scored less than mean value to question assessing fear of childbirth at institutions [19]. Knowledge about danger signs of pregnancy, labor, and following childbirth: Knowledge about danger sign was assessed based on the women’s response to eight knowledge questions. Thus, women’s were considered as they have good knowledge if they answered correctly to four or more knowledge question [20]. Women’s Attitude about skilled birth services: A total of 7 questions were used to assess attitude. Women responded to each question in the form of very agree, agree, disagree, and very disagree. Very agree and Agree was labeled as value "1", and disagree and very disagree was as assigned value "0". Women were considered as they have positive attitudes if all questions were labeled a value "1", and negative attitudes if any of the questions are labeled "0" [17]. The collected data were coded and entered into Epi-Data version 4.4.2.1 software and exported to SPSS statistical software version 25 for data cleaning and further analysis. Errors related to the inconsistency of data were checked and corrected during data cleaning. Descriptive statistical analyses such as simple frequencies, percentage, median and interquartile range were used to describe the characteristics of participants. The binary logistic regression model was fitted to identify factors associated with preference of homebirth after checking assumptions. Multi co-linearity by co-linearity matrix among the independent variables was checked. Bi-variable logistic regression analysis was performed between preference of homebirth and each of the independent variables, in sequence. Variables having a p-value of <0.25 in bi-variable logistic regression were a potential candidate for multivariable logistic regression analysis to control confounders in regression models. Variables having a p-value of less than 0.05 in the multivariable logistic regression model were considered as statistically significant. The final model was fitted with Hosmer and Lemeshow (p-value = 0.966). The strength of association between the preference of homebirth and independent variables were reported by using the adjusted odds ratio (AOR) with 95% CI. An ethical clearance letter was obtained from Arba Minch University, college of medicine, and health sciences research review board in 25/03/2021 with reference number IRB/1071/21. Written Permission was sought from the Health and demographic surveillance site, Arba Minch zuria and Gacho Baba districts. Written consent was obtained from each study participant before data collection and the purpose of the study was explained to the respondents. To protect confidentiality names and personal identification were not included in questionnaires. During data collection at the end of each interview women who prefer home birth were advised about the risk of home delivery. The issue of worldwide COVID 19 preventive approaches like social distancing face masks and hand sanitizer was practiced during data collection.

AI Digest

Study Justification:

The study aimed to assess the preference of home birth and associated factors among pregnant women in Arba Minch health and demographic surveillance site, Southern Ethiopia. This study is important because home birth with unskilled birth attendants is a leading indicator for maternal and newborn death. Understanding the prevalence of home birth preference and the factors associated with it can help inform interventions and policies to improve maternal and newborn health outcomes in the region.

Highlights:

– The prevalence of preference for home birth among pregnant women in Arba Minch health and demographic surveillance site was found to be 24%.
– Factors significantly associated with the preference for home birth included husband involvement in decision making, lack of road access for transportation, lack of awareness about the benefits of institutional birth, poor knowledge about danger signs, negative attitude toward services, and high fear of giving birth at health institutions.

Recommendations for Lay Reader:

– Pregnant women should be encouraged to involve their husbands in decision making regarding place of birth, as this was found to be a significant factor influencing home birth preference.
– Efforts should be made to improve road infrastructure and transportation options to increase access to health institutions for pregnant women.
– Health education programs should be implemented to raise awareness about the benefits of institutional birth and the potential dangers of home birth with unskilled birth attendants.
– There is a need to improve knowledge about danger signs during pregnancy, labor, and following childbirth among pregnant women.
– Addressing negative attitudes toward services and reducing fear of giving birth at health institutions are important in promoting institutional birth.

Recommendations for Policy Maker:

– Policies should be developed and implemented to promote husband involvement in decision making during pregnancy and childbirth.
– Investments should be made in improving road infrastructure and transportation services to ensure pregnant women have access to health institutions.
– Health education programs should be integrated into existing maternal and child health services to raise awareness about the benefits of institutional birth and the risks associated with home birth.
– Training programs should be developed for healthcare providers to improve their knowledge and skills in managing childbirth and addressing the fear and negative attitudes of pregnant women toward health services.
– Collaborative efforts between the health sector, community leaders, and other stakeholders should be established to address the cultural and social factors influencing home birth preference.

Key Role Players:

– Health extension workers
– Community leaders
– Healthcare providers
– Policy makers
– Non-governmental organizations (NGOs)
– Community-based organizations (CBOs)
– Women’s associations

Cost Items for Planning Recommendations:

– Training programs for healthcare providers
– Health education materials and campaigns
– Road infrastructure development
– Transportation services
– Community engagement activities
– Monitoring and evaluation of interventions
– Research and data collection

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a community-based cross-sectional study conducted in Arba Minch Health and Demographic Surveillance Site. The study used a simple random sampling technique to select 416 study samples. Data were collected using an interviewer-administered questionnaire and analyzed using bi-variable and multivariable binary logistic regression. The prevalence of preference for home birth among pregnant women in Arba Minch was found to be 24%. The study identified several factors significantly associated with the preference for home birth. The evidence is based on a well-defined study design and statistical analysis, but it is limited to a specific geographic area and may not be generalizable to other settings. To improve the strength of the evidence, future studies could consider using a larger sample size and a more diverse population to increase the external validity of the findings.

Abstract

A community-based cross-sectional study was conducted in Arba Minch Health and Demographic Surveillance Site. Arba Minch Health and Demographic Surveillance Site are located in Arba Minch Zuria and Gacho Baba districts, Gamo Zone, Southern Ethiopia, 500 km to the South of Addis Ababa, the capital city of Ethiopia. Arba Minch Zuria district and Gacho Baba district had a total of 31 kebeles [smallest administrative units] and it is included under Arba Minch Zuria Demographic and Health Development Program (AM-DHDP). AM-DHDP is owned by Arba Minch University and it is one of the six public universities Health and Demographic Surveillance System (HDSS) in Ethiopia. The surveillance site consists of nine kebeles which were selected in the representation of 31 kebeles in the district. From them, 6 kebeles were found in Arba Minch zuria district, and the rest three were found in Gacho baba districts. Farming is the predominant occupation of residents in the districts. Based on the 2007 census projection, the districts had a total population of 164,529. The district has 7 health centers and 37 health posts [15]. Around 81.8% of women gave birth at home in Arba Minch Zuria district [16]. Data were collected from May 1- June 1, 2021 from randomly selected pregnant women of Arba Minch zuria woreda. Pregnant women living in selected nine Kebeles of Arba Minch health and demographic surveillance site were study population for this study. Pregnant women living in Arba Minch health and demographic surveillance site included in the study. Pregnant women with severely illness as well as those who were in labor during data collection period were excluded. The sample size was determined by using a single population proportion formula, by considering the following assumptions; taking a proportion of home birth preference conducted in Simada district Ahmara region, Ethiopia, 56.4% proportion, 95% confidence level and power 80 considering 10% non-response rates [11]. Where; n = the desired sample size. Zα/2 = Standard normal deviate of 1.96 which corresponds to 95% confidence level (z value at Alpha = 0.05). P = Proportion of home birth (56.4%). d = an absolute precision (margin of error0 which is 5%. Hence study was conducted in Arba Minch health and demographic surveillance site registration and identification of the women becoming pregnant with their address is one of the core and continuum activities of the health extension workers assigned to the woreda. Since study was conducted in Arba Minch health and demographic surveillance site, the list of pregnant women was obtained from health extension workers working in Arba Minch health and demographic surveillance site. The total number of pregnant women obtained from health extension workers from nine kebeles of Arba Minch health and demographic surveillance site were 610. Before the selection of study participants, proportions to size allocations to each kebele were done. From the list, the required sample size (416) was selected by simple random sampling using computer-generated numbers from each kebele as per the proportions to size allocation to each kebele. The data were collected by using structured interviewer-administered questionnaire. The questionnaires contain questions about socio-demographic characteristics, service-related, obstetrical characteristics, knowledge on danger signs, attitude toward skilled birth services, and fear of childbirth at a health institution. These questionnaires were adapted and developed from published related literatures [11, 12, 17–20]. Nine Health and demographic surveillance site data collectors and three supervisors were used. The data were collected using interviewer-administered questionnaire with participants at their homes. Preference of homebirth was obtained from the question asked to pregnant women; “where do you prefer to give birth?” Response to this question was either of home birth or health facility [hospital, health Centre/clinic, health post, and private hospital/clinic] [11]. To assure the data quality the questionnaires were translated from English to Amharic and retranslated to English for a consistent and proper check. The pre-test was done on a sample of 21 pregnant women (5% of sample size) in Mirab Abaya woreda southern part of Ethiopia. The internal consistency of the tool was assessed by a reliability test (Cronbach’s alpha). The values of Cronbach’s alpha were 0.743, 0.841, and 0.919 for knowledge, attitude, and fear of childbirth at institution questions respectively. Two days of training on data collection procedures, and the objectives of the study for data collectors and supervisors were provided. Collected data was checked for completeness on daily basis by data collectors and supervisors. Dependent variable. Preference of home birth. “Preference of home birth” was the dependent variable and was obtained from the question, “Where do you prefer/need to give birth [choices]?” Response to this question was prefer/need to give birth at home or at government hospital/health center or private hospital/clinic. It was then dichotomized to into prefer health facility birth = 0 and prefer home birth = 1 where respondent’s preference/need to give birth at home “prefer home birth” and all the other categories were grouped as “prefer health facility birth” [11]. Independent variables. The independent variables considered in this study were age of the women, marital status, ethnicity, religion, women educational status, women occupation, husband educational status, husband occupation, household income, residence, family size, Gravid, pregnancy desire, last place of delivery, last mode of delivery, last birth complication, current ANC status, number of ANC follow up, birth interval, distance from health services/facility, road access for transportation to health institutions, information on the benefit of institutional birth, Knowledge of danger signs, attitude toward skilled birth services, decision-making, and fear of childbirth at the institution. Operational definitions. Women’s fear of childbirth at health institution: A total of 13 items were presented to assess fear of childbirth at the health institution. Women responded to their level of fear for each item by a 4-point Likert scale. The women were classified as high fear if they scored mean value and above, and low fear if they scored less than mean value to question assessing fear of childbirth at institutions [19]. Knowledge about danger signs of pregnancy, labor, and following childbirth: Knowledge about danger sign was assessed based on the women’s response to eight knowledge questions. Thus, women’s were considered as they have good knowledge if they answered correctly to four or more knowledge question [20]. Women’s Attitude about skilled birth services: A total of 7 questions were used to assess attitude. Women responded to each question in the form of very agree, agree, disagree, and very disagree. Very agree and Agree was labeled as value "1", and disagree and very disagree was as assigned value "0". Women were considered as they have positive attitudes if all questions were labeled a value "1", and negative attitudes if any of the questions are labeled "0" [17]. The collected data were coded and entered into Epi-Data version 4.4.2.1 software and exported to SPSS statistical software version 25 for data cleaning and further analysis. Errors related to the inconsistency of data were checked and corrected during data cleaning. Descriptive statistical analyses such as simple frequencies, percentage, median and interquartile range were used to describe the characteristics of participants. The binary logistic regression model was fitted to identify factors associated with preference of homebirth after checking assumptions. Multi co-linearity by co-linearity matrix among the independent variables was checked. Bi-variable logistic regression analysis was performed between preference of homebirth and each of the independent variables, in sequence. Variables having a p-value of <0.25 in bi-variable logistic regression were a potential candidate for multivariable logistic regression analysis to control confounders in regression models. Variables having a p-value of less than 0.05 in the multivariable logistic regression model were considered as statistically significant. The final model was fitted with Hosmer and Lemeshow (p-value = 0.966). The strength of association between the preference of homebirth and independent variables were reported by using the adjusted odds ratio (AOR) with 95% CI. An ethical clearance letter was obtained from Arba Minch University, college of medicine, and health sciences research review board in 25/03/2021 with reference number IRB/1071/21. Written Permission was sought from the Health and demographic surveillance site, Arba Minch zuria and Gacho Baba districts. Written consent was obtained from each study participant before data collection and the purpose of the study was explained to the respondents. To protect confidentiality names and personal identification were not included in questionnaires. During data collection at the end of each interview women who prefer home birth were advised about the risk of home delivery. The issue of worldwide COVID 19 preventive approaches like social distancing face masks and hand sanitizer was practiced during data collection.

Materials

Innovations

Based on the provided information, here are some potential innovations that could be recommended to improve access to maternal health:

1. Mobile health clinics: Implementing mobile health clinics that can travel to remote areas and provide maternal health services, including prenatal care, delivery assistance, and postnatal care. This would help reach pregnant women who have limited access to healthcare facilities.

2. Telemedicine: Introducing telemedicine services to provide remote consultations and support for pregnant women. This would enable healthcare professionals to provide guidance and advice to women who prefer homebirth, ensuring they have access to necessary information and assistance.

3. Community health workers: Training and deploying community health workers who can provide education, support, and basic healthcare services to pregnant women in their homes. These workers can help address the lack of skilled birth attendants during homebirths and ensure that women receive appropriate care.

4. Improving transportation infrastructure: Investing in road infrastructure to improve access to healthcare facilities. This would address the issue of limited road access for transportation to health institutions, which was identified as a significant factor in the preference for homebirth.

5. Health education campaigns: Conducting targeted health education campaigns to raise awareness about the benefits of institutional birth and the risks associated with homebirth. This would help address the lack of knowledge about the benefits of institutional birth, which was identified as a factor influencing the preference for homebirth.

6. Engaging husbands in decision-making: Implementing programs that promote the involvement of husbands in decision-making regarding childbirth. This would help address the finding that husband involvement in decision-making was significantly associated with the preference for homebirth.

7. Addressing fear of childbirth at health institutions: Developing interventions to address the high fear of childbirth at health institutions. This could include counseling services, support groups, and creating a more welcoming and supportive environment in healthcare facilities.

These innovations have the potential to improve access to maternal health services and reduce the preference for homebirth with unskilled birth attendants, ultimately leading to a decrease in maternal and newborn deaths.

AI Innovations Description

The study titled “Preference of homebirth and associated factors among pregnant women in Arba Minch health and demographic surveillance site, Southern Ethiopia” aimed to assess the preference of home birth and identify associated factors among pregnant women in Arba Minch health and demographic surveillance site.

The study was conducted in Arba Minch Health and Demographic Surveillance Site, located in Arba Minch Zuria and Gacho Baba districts, Gamo Zone, Southern Ethiopia. The site consists of nine kebeles (administrative units) selected to represent the 31 kebeles in the district. The population of the districts was 164,529 according to the 2007 census projection. The districts have 7 health centers and 37 health posts.

The study used a community-based cross-sectional design and collected data from May 1 to June 1, 2021. The sample size was determined using a single population proportion formula, and 416 pregnant women were selected using simple random sampling. Data were collected through structured interviewer-administered questionnaires, which included questions about socio-demographic characteristics, service-related factors, obstetrical characteristics, knowledge of danger signs, attitude toward skilled birth services, and fear of childbirth at a health institution.

The prevalence of preference for home birth among pregnant women in Arba Minch health and demographic surveillance site was found to be 24%. Factors significantly associated with the preference of home birth included husband involvement in decision making, lack of road access for transportation, lack of awareness about the benefits of institutional birth, poor knowledge of danger signs, negative attitude toward services, and high fear of giving birth at a health institution.

The study provides important insights into the factors influencing the preference for home birth in the study area. Based on these findings, recommendations can be made to develop innovations to improve access to maternal health. Some potential recommendations could include:

1. Increasing awareness: Implement targeted awareness campaigns to educate pregnant women and their families about the benefits of institutional birth and the risks associated with home birth. This can be done through community health workers, local media, and community engagement activities.

2. Improving transportation infrastructure: Address the lack of road access for transportation by improving infrastructure and ensuring reliable transportation options to health facilities. This can include building or repairing roads, providing transportation subsidies, or establishing community-based transportation systems.

3. Enhancing knowledge of danger signs: Develop and implement educational programs to improve pregnant women’s knowledge of danger signs during pregnancy, labor, and postpartum. This can be done through antenatal care services, community health education sessions, and mobile health applications.

4. Promoting positive attitudes: Conduct sensitization programs to address negative attitudes toward skilled birth services. This can involve engaging community leaders, religious leaders, and traditional birth attendants to promote positive attitudes and support for institutional birth.

5. Addressing fear of childbirth at health institutions: Provide counseling and support services to address women’s fear of childbirth at health institutions. This can include psychological support, birth preparedness classes, and involving women in decision-making processes related to their childbirth experience.

These recommendations can contribute to improving access to maternal health services and reducing the preference for home birth with unskilled birth attendants, ultimately leading to a reduction in maternal and newborn mortality rates.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement comprehensive awareness campaigns to educate pregnant women and their families about the benefits of institutional birth and the risks associated with homebirth. This can be done through community outreach programs, health education sessions, and the use of media platforms.

2. Improve transportation infrastructure: Address the issue of limited road access for transportation to health institutions by improving the transportation infrastructure in the area. This can include building or repairing roads, providing transportation services, or implementing mobile health clinics to reach remote areas.

3. Strengthen antenatal care services: Enhance antenatal care services by ensuring that pregnant women have access to regular check-ups, screenings, and counseling. This can help identify any potential complications early on and provide appropriate interventions.

4. Promote husband involvement: Encourage husband involvement in decision-making regarding childbirth. This can be achieved through community sensitization programs that emphasize the importance of shared decision-making and the role of husbands in supporting their wives during pregnancy and childbirth.

5. Enhance knowledge about danger signs: Conduct educational programs to improve knowledge about danger signs during pregnancy, labor, and postpartum. This can empower women to recognize potential complications and seek timely medical assistance.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that can measure the impact of the recommendations, such as the percentage of pregnant women choosing institutional birth, the number of women receiving antenatal care, or the reduction in maternal and newborn mortality rates.

2. Collect baseline data: Gather baseline data on the current status of access to maternal health in the study area, including the prevalence of homebirth preference, transportation infrastructure, antenatal care coverage, and knowledge about danger signs.

3. Implement interventions: Implement the recommended interventions, such as awareness campaigns, infrastructure improvements, and strengthening of antenatal care services. Monitor the implementation process and ensure that the interventions are reaching the target population.

4. Collect post-intervention data: After a sufficient period of time, collect post-intervention data using the same indicators as the baseline data. This will allow for a comparison of the impact of the interventions on access to maternal health.

5. Analyze and evaluate the data: Analyze the data collected before and after the interventions to assess the impact on access to maternal health. Calculate the changes in the indicators and determine the effectiveness of each recommendation.

6. Adjust and refine interventions: Based on the evaluation results, make any necessary adjustments or refinements to the interventions to further improve access to maternal health. This could include scaling up successful interventions or addressing any challenges or barriers that were identified during the evaluation.

7. Monitor and sustain improvements: Continuously monitor the indicators and sustain the improvements achieved by regularly evaluating the interventions and making any necessary adjustments. This will ensure that access to maternal health remains a priority and continues to improve over time.

Authors & Co-Authors

Statistics:

Authors: 6

Identifiers:

DOI: 10.1371/journal.pone.0276682

Research Areas:

Community Interventions, COVID, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female