Women's Choice to Deliver at Home: Understanding the Psychosocial and Cultural Factors Influencing Birthing Choices for Unskilled Home Delivery among Women in Southwestern Uganda.

Publisher: Hindawi Pub. Corp Country of Publication: Egypt NLM ID: 101553823 Publication Model: eCollection Cited Medium: Internet ISSN: 2090-2735 (Electronic) Linking ISSN: 20902727 NLM ISO Abbreviation: J Pregnancy Subsets: MEDLINE

Original Publication: Cairo : Hindawi Pub. Corp.

Choice Behavior* ; Culture* ; Home Childbirth* ; Psychology*; Pregnancy/*psychology; Female ; Humans ; Maternal Mortality ; Patient Acceptance of Health Care/statistics & numerical data ; Perinatal Care/statistics & numerical data ; Uganda/epidemiology

Background: Utilization of perinatal services in Uganda remains low, with correspondingly high rates of unskilled home deliveries, which can be life-threatening. We explored psychosocial and cultural factors influencing birthing choices for unskilled home delivery among postpartum women in rural southwestern Uganda.
Methods: We conducted in-depth qualitative face-to-face interviews with 30 purposively selected women between December 2018 and March 2019 to include adult women who delivered from their homes and health facility within the past three months. Women were recruited from 10 villages within 20 km from a referral hospital. Using the constructs of the Health Utilization Model (HUM), interview topics were developed. Interviews were conducted and digitally recorded in a private setting by a native speaker to elicit choices and experiences during pregnancy and childbirth. Translated transcripts were generated and coded. Coded data were iteratively reviewed and sorted to derive categories using inductive content analytic approach.
Results: Eighteen women (60%) preferred to deliver from home. Women's referent birth location was largely intentional. Overall, the data suggest women choose home delivery (1) because of their financial dependency and expectation for a " natural " and normal childbirth, affecting their ability and need to seek skilled facility delivery; (2) as a means of controlling their own birth processes; (3) out of dissatisfaction with facility-based care; (4) out of strong belief in fate regarding birth outcomes; (5) because they have access to alternative sources of birthing help within their communities, perceived as " affordable ," " supportive ," and " convenient "; and (6) as a result of existing gender and traditional norms that limit their ability and freedom to make family or health decisions as women.
Conclusion: Women's psychosocial and cultural understandings of pregnancy and child birth, their established traditions, birth expectations, and perceptions of control, need, and quality of maternity care at a particular birthing location influenced their past and future decisions to pursue home delivery. Interventions to address barriers to healthcare utilization through a multipronged approach could help to debunk misconceptions, increase perceived need, and motivate women to seek facility delivery.
Competing Interests: All authors declare that they have no conflicts of interest.
(Copyright © 2020 Esther C. Atukunda et al.)

Reprod Health. 2014 Sep 19;11(1):71. (PMID: 25238684)
Reprod Health. 2018 Jan 11;15(1):9. (PMID: 29325572)
BMC Pregnancy Childbirth. 2016 Oct 5;16(1):295. (PMID: 27716090)
J Glob Health. 2016 Jun;6(1):010401. (PMID: 26649177)
BMC Health Serv Res. 2016 Oct 19;16(1):592. (PMID: 27760531)
BMC Health Serv Res. 2018 Oct 4;18(1):758. (PMID: 30286749)
BMC Pregnancy Childbirth. 2017 Aug 31;17(1):267. (PMID: 28854901)
Australas Med J. 2011;4(9):516-26. (PMID: 23393544)
J Biosoc Sci. 2007 Jan;39(1):109-20. (PMID: 16522226)
Midwifery. 2016 May;36:80-5. (PMID: 27106947)
AIDS Behav. 2017 Feb;21(2):428-440. (PMID: 27671479)
Soc Sci Med. 2015 Apr;130:242-9. (PMID: 25728484)
BMC Pregnancy Childbirth. 2013 May 08;13:108. (PMID: 23656701)
Reprod Health. 2017 Oct 17;14(1):132. (PMID: 29041972)
Qual Health Res. 2005 Nov;15(9):1277-88. (PMID: 16204405)
BMC Health Serv Res. 2015 Jul 20;15:274. (PMID: 26188472)
PLoS One. 2019 May 9;14(5):e0216027. (PMID: 31071125)
Reprod Health. 2013 Aug 20;10:40. (PMID: 23962135)
BMC Pregnancy Childbirth. 2017 Jul 14;17(1):225. (PMID: 28705188)
Lancet. 2016 Feb 6;387(10018):604-616. (PMID: 26794073)
Lancet. 2016 Feb 6;387(10018):587-603. (PMID: 26794078)
Glob Health Action. 2011;4:. (PMID: 22216018)
Afr J Reprod Health. 2013 Sep;17(3):30-43. (PMID: 24069765)
PLoS Med. 2013;10(2):e1001382. (PMID: 23424286)
Annu Rev Psychol. 2018 Jan 4;69:275-298. (PMID: 28961059)
J Health Soc Behav. 1995 Mar;36(1):1-10. (PMID: 7738325)
Int J Qual Health Care. 2009 Jun;21(3):206-13. (PMID: 19258342)
Matern Child Health J. 2013 Feb;17(2):230-9. (PMID: 22359241)
PLoS One. 2016 May 04;11(5):e0154664. (PMID: 27144393)
BMC Pregnancy Childbirth. 2009 Aug 11;9:34. (PMID: 19671156)
Afr J Reprod Health. 2012 Sep;16(3):102-18. (PMID: 23437504)
Lancet Glob Health. 2019 Aug;7(8):e1074-e1087. (PMID: 31303295)
J Altern Complement Med. 2009 Aug;15(8):911-9. (PMID: 19678783)
PLoS One. 2012;7(9):e45053. (PMID: 22984608)
J Ethnobiol Ethnomed. 2011 Jan 17;7:7. (PMID: 21241484)
Int J Gynaecol Obstet. 2007 Mar;96(3):220-5. (PMID: 17292370)
Reprod Health Matters. 2003 May;11(21):16-26. (PMID: 12800700)
BMC Public Health. 2017 Apr 4;17(1):289. (PMID: 28372540)
PLoS One. 2019 Mar 11;14(3):e0213511. (PMID: 30856217)
Open J Prev Med. 2015 Mar 1;5(3):132-142. (PMID: 26042190)
Midwifery. 2012 Oct;28(5):554-60. (PMID: 22884893)
Appl Psychol Health Well Being. 2017 Mar;9(1):81-105. (PMID: 27925435)
Soc Sci Med. 2012 Feb;74(3):452-459. (PMID: 22196965)
Health Care Manage Rev. 2011 Oct-Dec;36(4):349-58. (PMID: 21685795)
WHO South East Asia J Public Health. 2018 Apr;7(1):36-42. (PMID: 29582848)
J Adv Nurs. 2004 Apr;46(2):212-9. (PMID: 15056335)
Psychol Health. 2011 Sep;26(9):1113-27. (PMID: 21929476)
Health Psychol Rev. 2015;9(2):131-7. (PMID: 26209198)
J Midwifery Womens Health. 2016 Jan-Feb;61(1):127-33. (PMID: 26676378)
BMC Pregnancy Childbirth. 2015 Feb 05;15:15. (PMID: 25652361)
Trop Med Int Health. 2007 Jul;12(7):862-72. (PMID: 17596254)
Midwifery. 2016 Oct;41:9-15. (PMID: 27494569)

K43 TW011004 United States TW FIC NIH HHS

Date Created: 20200623 Date Completed: 20200817 Latest Revision: 20231111

20240829

PMC7290878

10.1155/2020/6596394

32566299