Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study

Khatri, RB; Dangi, TP; Gautam, R; Shrestha, KN; Homer, CSE

Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study

Khatri, RB Dangi, TP Gautam, R Shrestha, KN Homer, CSE

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Publication Type:: Journal Article
Citation:: PLoS ONE, 2017, 12 (5)
Issue Date:: 2017-05-01

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Field	Value	Language
dc.contributor.author	Khatri, RB	en_US
dc.contributor.author	Dangi, TP	en_US
dc.contributor.author	Gautam, R	en_US
dc.contributor.author	Shrestha, KN	en_US
dc.contributor.author	Homer, CSE https://orcid.org/0000-0002-7454-3011	en_US
dc.date.available	2017-04-28	en_US
dc.date.issued	2017-05-01	en_US
dc.identifier.citation	PLoS ONE, 2017, 12 (5)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/98453
dc.description.abstract	© 2017 Khatri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Maternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers. Methods: We conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis. Results: Irregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center. Conclusion: The rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries.	en_US
dc.relation.ispartof	PLoS ONE	en_US
dc.relation.isbasedon	10.1371/journal.pone.0177602	en_US
dc.subject.classification	General Science & Technology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Delivery, Obstetric	en_US
dc.subject.mesh	Trust	en_US
dc.subject.mesh	Demography	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Qualitative Research	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Rural Population	en_US
dc.subject.mesh	Birthing Centers	en_US
dc.subject.mesh	Maternal Health Services	en_US
dc.subject.mesh	Nepal	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Young Adult	en_US
dc.title	Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study	en_US
dc.type	Journal Article
utslib.citation.volume	5	en_US
utslib.citation.volume	12	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	/University of Technology Sydney/Strength - WHO CC
utslib.copyright.status	open_access
pubs.issue	5	en_US
pubs.publication-status	Published	en_US
pubs.volume	12	en_US

Abstract:

© 2017 Khatri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Maternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers. Methods: We conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis. Results: Irregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center. Conclusion: The rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries.

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http://hdl.handle.net/10453/98453