Socio-cultural Beliefs and Practices Influencing Institutional Delivery Service Utilization in Three Communities of Ethiopia A Qualitative Study

Abstract

BACKGROUND: The influence of socio-cultural factors oninstitutional birth is not sufficiently documented in Ethiopia.Thus, this study explores socio-cultural beliefs and practicesduring childbirth and its influences on the utilization ofinstitutional delivery services.

METHODS: A qualitative study was conducted in three regions ofEthiopia through eight focus group discussions (with women) andthirty in-depth interviews with key informants which includedhealth workers, community volunteers, and leaders. The data wereanalyzed thematically.

RESULTS: The study identified six overarching socio-culturalfactors influencing institutional birth in the study communities.The high preference for traditional birth attendants (TBAs) andhome as it is intergenerational culture and suitable for privacy areamong the factors. Correspondingly, culturally unacceptable birthpractices at health facilities (such as birth position, physicalassessment, delivery coach) and inconvenience of health facilitysetting to practice traditional birth rituals such as newbornwelcoming ceremony made women avoid health facility birth. Onthe other hand, misperceptions and worries on medicalinterventions such as episiotomy, combined with mistreatmentfrom health workers, and lack of parent engagement in deliveryprocess discouraged women from seeking institutional birth. Theprovision of delivery service by male health workers was cited as asocial taboo and against communities' belief system whichprohibited women from giving birth at a health facility.

CONCLUSIONS: Multiple socio-cultural factors and perceptionswere generally affected utilization of institutional birth in studycommunities. Hence, culturally competent interventions througheducation, re-orientation, and adaptation of beneficial normscombined with women friendly care are essential to promotehealth facility birth.