The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #69405

Pamela L. Bolton, MHS¹, Ellen Brazier, MIA², Michelle Trombley, BA³, Djénéba Diallo, MPH⁴, Brahima Bassane, MD⁴, Rita Noronha, MD⁵, and Isabella Chege⁶. (1) Francophone Africa Program, Family Care International, 588 Broadway, Suite 503, New York, NY 10012, (212) 941-5300, pbolton@familycareintl.org, (2) Anglophone Africa Program, Family Care International, 588 Broadway, Suite 503, New York, NY 10012, (3) Skilled Care Initiative, Family Care International, 588 Broadway, Suite 503, New York, NY 10012, (4) Burkina Faso Country office, Family Care International, c/o 588 Broadway, Suite 503, New York, NY 10012, (5) Ubora wa Afya (FCI) Tanzania Country office, Family Care International, 588 Broadway, Suite 503, New York, NY 10012, (6) Kenya Country office, Family Care International, c/o 588 Broadway, Suite 503, New York, NY 10012

To increase understanding of local knowledge, attitudes, and behaviors related to childbirth and communities’ use of skilled care for delivery, FCI carried out in-depth, qualitative studies in rural districts of Burkina Faso, Kenya and Tanzania. Trained interviewers conducted over 300 in-depth individual and group interviews with women having had normal deliveries, women who experienced serious obstetrical complications, husbands, elder family members, community leaders, and health providers. Innovative study methods included complication narratives and projective interview techniques. Themes explored were: preparations for birth, nature of family dialogue and decision-making processes, care perceptions and preferences, recognition of/response to complications, and strategies for coping with transport and costs. Interviews were recorded, transcribed and analyzed using accepted qualitative techniques. In all settings studied, material and financial preparations for birth were made late in pregnancy or even once labor began. Generally very little discussion took place among couples or families around preparations for childbirth or place of delivery. There were few cultural traditions of preparing for a possible problem or emergency situation. Elder family members (male and female) had the most decision-making power about when a woman should seek care. Once families decided to seek skilled care, the route to the hospital was circuitous, with delays in mobilizing transport and funds, trying different providers, etc.

The presentation will highlight differences among the three communities. It will describe how results are being used to inform local design of behavior change initiatives aimed at increasing use of skilled attendance at delivery.

Learning Objectives:

• Cite the importance of increased use of skilled (professional) care at delivery in reducing maternal deaths in poor countries
• Explain major familial and social factors affecting care-seeking behaviors in pregnancy and childbirth in a rural African context
• Describe the process in which families engage when deciding to seek care, then accessing care for normal birth or complications ƒv Apply the study findings to suggest several intervention strategies to increase use of skilled care in similar settings

Keywords: Behavioral Research, Maternal Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.