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Background: Facility based delivery for mothers is one of the proven interventions to reduce maternal and neonatal morbidity and mortality. This study identified women’s reasons for seeking to give birth in a health facility and captured their perceptions of the quality of care they received during their most recent birth, in a population with high utilization of facility based deliveries. Methods: This qualitative study was conducted in eight health centers in Addis Ababa. Women bringing their index child for first vaccinations were invited to participate in an in-depth interview about their last delivery. Sixteen in-depth interviews were conducted. Interviews were conducted by trained researchers using a semi-structured interview guide. The data were transcribed verbatim in Amharic and translated into English. A thematic analysis was conducted to answer specific study questions. Results: All research participants expressed a preference for facility based delivery because of their awareness of obstetric complications, and related perceptions that facility-birth is safer for the mother and child. Dimensions of quality of care and the cost of services were identified as influencing decisions about whether to seek care in the public or private sector. Media campaigns, information from social networks and women’s experiences with healthcare providers and facilities influenced care-seeking decisions. Conclusions: The universal preference for facility-based birth by women in this study indicates that, in Addis Ababa, facility based delivery has become a preferred norm. Sources of information for decision-making and the dimensions of quality prioritized by women should be taken into account to develop interventions to promote facility-based births in other settings.
This study was conducted in public health facilities that provide childhood immunization services. The government health centers that were sampled in this study, are part of the St. Paul’s Millennium College Hospital referral network, in Addis Ababa, Ethiopia. According to EDHS 2011, the total fertility rate was 1.5 children per woman in Addis Ababa [4]. A qualitative study was undertaken to understand the factors that have contributed to a woman’s choice to deliver in a health facility and her perception of the quality of care provided. In 2009/10, the Ethiopian government started providing free antenatal care, delivery and postnatal in all public health centers. In Ethiopia, the first vaccination is normally scheduled at six weeks after birth. Postnatal women attending the first routine vaccination for their last born child (index child) in the study period from each of the participating urban health facilities in Addis Ababa were invited to participate. A purposive sampling procedure was used to identify women who were first time mothers as well as women who had had more than one birth from each health facility participating in the study. Sample size was determined using the principle of “saturation”—women were asked to participate in interviews until additional interviews did not provide additional evidence about the main themes of interest [10]. In-depth interviews were conducted to gather information on personal experiences with seeking facility based care. Interviews were conducted by five researchers with graduate level training in qualitative methods. Informed consent was obtained from all respondents. Interviews were conducted using a semi-structured interview guide, which was prepared in Amharic (local language). On average interviews took about 30 min. Each woman completed only one interview, but interviews were conducted during two time periods (August and December 2013). This allowed data collection and analysis to inform each other mutually [11]. Analysis of the first round of data collection allowed for identification of themes and gaps in the information which were explored in greater depth during interviews conducted during the second period of data collection. The tape recorded interviews were transcribed in Amharic and translated into English by the researchers. The translated data were exported into Open Code software to facilitate coding and analysis. Each translated document was coded line-by-line to flag ideas and statements related to the study objective, and then codes were grouped to identify themes that were related to the factors that influence women’s decision to seek institutional delivery. A priori themes were coded based on the study objectives and emergent themes were identified based on the narratives of research participants. Addis Continental Institute of Public Health ethical review board approved the study. Written informed consent was sought from each participant before the interview began, and after explaining the purpose of the study. The decision to participate in the study was not linked to the service participants were entitled to obtain. Written consent was archived at the Addis Continental Institute of Public Health data management unit. All participants received a unique identification number that was used on the recorded interviews, on the transcripts and also during publication. The entire interview was recorded, and after transcription, the cassette was discarded. Access to the raw data was limited only the research team members. To ensure privacy, all interviews were conducted in a private room within the health facility.
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