A North Ugandan study of why women do not give birth at health facilities recommends a family inclusive approach: health education for women, families and communities; and enhancing male involvement and support.

The study, situated in Gulu District, included interviews with pregnant women, mothers, healthcare providers, policy makers and community leaders. It also included 6 focus groups in communities, each involving 10 people. Two of these were for men. There were no interviews with husbands/fathers.

The study was led by Erin Anastasi of UNFPA in New York with a team of researchers from Uganda, UK, Germany and Spain.

A questionnaire about how the decision is made about where to give birth found a high level of family involvement – only 27% of the women made the decision themselves. Others made it jointly with their husband (30%) or had the decision made for them by someone else (husband – 32%; other family member – 11%).

One of the barriers to use of health facilities is “lack of support from husband or partner”. The article, however, does not present the evidence around this in the results section and there is also no report from the 20 men involved in the two focus groups, so it is not possible to understand this finding from the text presented, nor what the evidence suggests should be done about it. The study does, however, recommend the same as other studies that do explore the role of husbands/partners, including talking with them directly: namely, that engagement will improve attendance at health facilities for the birth.

Another barrier reported is fear of health facilities. The study refers to a family inclusive innovation being carried out at one Ugandan hospital (outside the study area): a welcome to birth companions at health facilities, with a chair provided for them in the labour room, and the organisation of tours of health centres for prospective users.

Another barrier is distance and cost of attending the facility, solutions to which would need the collaboration of the family.

Anastasi E, Borchert M, Campbell OMR, Sondorp E, Kaducu F, Hill O, Okeng D, Odong VN & Lange IL (2015), Losing women along the path to safe motherhood: why is there such a gap between women’s use of antenatal care and skilled birth attendance? A mixed methods study in northern Uganda, BMC Pregnancy and Childbirth 15

Photo: Adam Bullied. Creative Commons.