A study in rural Bangladesh explored why so many mothers still give birth at home rather than in a health centre. 66 interviews were carried out in 2012 and 2013 with mothers, health workers and community members. The only group not approached were husbands, though according to other research in the same location, husbands are involved in the decision-making in 78% of the families.

The reasons for preferring birth at home with a traditional birth attendant are similar to those found in other studies:

• cultural assumptions (e.g. a lowering of the social status of a woman who is considered to have exposed herself to an unknown male doctor)
• the cost of going to a health clinic for poor families
• trust in local traditional birth attendants
• lack of information and knowledge (many families are not literate)
• religious beliefs (e.g. the belief in purdah for women having babies)
• poor road conditions
• fear of health clinics (e.g. the possibility of a Caesarean section)
• influence of family members – elders, husbands

The study finds that elderly women in families have a particularly strong voice and are likely to advocate for the traditional practices that existed when they had babies.

In other research carried out in the same region, the husband made the decision about healthcare in 50% of families and in 28% of families, it was a joint decision. This is extrapolated to say that men in families are a barrier to the use of health clinics.

But the study did not ask the husbands, so the researchers did not find out what they think. Nor does the study show how lack of information for these individuals may be impacting on decision-making.

We have reported here several studies in which men in families are included in questioning by researchers. A study in Burkina Faso found that husbands are no less likely to want a home birth than the women themselves. We have reported on similar findings in Ethiopia and Uganda.

The researchers conclude that programmes should engage with elderly women in families, but offer no suggestions for how to engage with the husbands in the 78% of families where he is involved in the decision-making about where to give birth.

Sarker BK, Rahman M, Rahman T, Hossain J, Reichenbach L & Mitra DK (2016), Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs) in Rural Bangladesh: A Qualitative Exploration, Plos One

Photo: Community Eye Health. Creative Commons.