See the published version of this article at BMC Pregnancy and Childbirth.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Factors influencing adoption of facility-assisted delivery - a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania
Paul D Mosley
Mennonite Central Committee
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0280-3224
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Pregnancy and Childbirth.
BACKGROUND: Tanzania’s One Plan II health sector program aims to increase facility deliveries from 50% to 80% from 2015-2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who robustly prefer home births to facility births even after completing 4+ ANC visits. Ebiotishu Oondomonok Ongera (EbOO) is a program in Nainokanoka ward to promote facility births through a care-group model using trained traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for delivery. A qualitative study was conducted to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver. METHODS: In-depth interviews, focus group discussions and key-informant interviews were conducted with 24 pregnant and/or parous women, 24 TBAs, 3 nurse midwives at 3 health facilities, and 24 married men, living in Nainokanoka ward. Interviews and discussions were transcribed, translated, and analyzed thematically using a grounded theory approach. RESULTS: Most women interviewed expressed preference for a home birth with a TBA and even those who expressed agency and preference for a facility birth usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery. TBAs report support for facility deliveries but in practice use them as a last resort, and a significant trust gap was documented based on a bad experience at a facility where women in labor were turned away. CONCLUSIONS: EbOO project data and study results show a slow but steady change in norms around delivery preference in Nainokanoka ward. Gaps between expressed intention and practice, especially around ‘unexpected labor’ present opportunities to accelerate this process by promoting birth plans and perhaps constructing a maternity waiting house in the ward. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services, and increased sensitivity to women’s cultural preferences, could also close the gap between the number of women who are currently using facilities for ANC and those returning for delivery.
Keywords
maternal and child health, MCH, RMNCH, antenatal care, ANC, facility delivery, care group, TBA, traditional birth attendant, Tanzania, Ngorongoro, Maasai
Figure 1
Figure 2
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 27 Dec, 2019
Published
On 12 Feb, 2020
No community comments so far
Editor assigned
On 23 Dec, 2019
Submission checks complete
On 22 Dec, 2019
Editor invited
On 22 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 09 Dec, 2019
Review #1 received
Received 08 Dec, 2019
Review #2 received
Received 08 Dec, 2019
Reviewer #2 agreed
On 27 Nov, 2019
Reviewer #1 agreed
On 23 Nov, 2019
Reviewers invited
Invitations sent on 22 Nov, 2019
Editor assigned
On 25 Oct, 2019
Submission checks complete
On 24 Oct, 2019
Editor invited
On 24 Oct, 2019
Community comments: 4
Editorial decision: Major revision
On 24 Sep, 2019
Review #2 received
Received 13 Sep, 2019
Review #1 received
Received 10 Sep, 2019
Reviewer #4 agreed
On 01 Sep, 2019
Review #4 received
Received 01 Sep, 2019
Review #3 received
Received 01 Sep, 2019
Reviewer #3 agreed
On 30 Aug, 2019
Reviewer #2 agreed
On 29 Aug, 2019
Editor assigned
On 27 Aug, 2019
Reviewers invited
Invitations sent on 27 Aug, 2019
Reviewer #1 agreed
On 27 Aug, 2019
Submission checks complete
On 26 Aug, 2019
Editor invited
On 17 Aug, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Maternal & Fetal Medicine
Learn more about our company.
This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Factors influencing adoption of facility-assisted delivery - a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania
Paul D Mosley
Mennonite Central Committee
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0280-3224
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 27 Dec, 2019
Published
On 12 Feb, 2020
No community comments so far
Editor assigned
On 23 Dec, 2019
Submission checks complete
On 22 Dec, 2019
Editor invited
On 22 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 09 Dec, 2019
Review #1 received
Received 08 Dec, 2019
Review #2 received
Received 08 Dec, 2019
Reviewer #2 agreed
On 27 Nov, 2019
Reviewer #1 agreed
On 23 Nov, 2019
Reviewers invited
Invitations sent on 22 Nov, 2019
Editor assigned
On 25 Oct, 2019
Submission checks complete
On 24 Oct, 2019
Editor invited
On 24 Oct, 2019
Community comments: 4
Editorial decision: Major revision
On 24 Sep, 2019
Review #2 received
Received 13 Sep, 2019
Review #1 received
Received 10 Sep, 2019
Reviewer #4 agreed
On 01 Sep, 2019
Review #4 received
Received 01 Sep, 2019
Review #3 received
Received 01 Sep, 2019
Reviewer #3 agreed
On 30 Aug, 2019
Reviewer #2 agreed
On 29 Aug, 2019
Editor assigned
On 27 Aug, 2019
Reviewers invited
Invitations sent on 27 Aug, 2019
Reviewer #1 agreed
On 27 Aug, 2019
Submission checks complete
On 26 Aug, 2019
Editor invited
On 17 Aug, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Maternal & Fetal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Pregnancy and Childbirth.
BACKGROUND: Tanzania’s One Plan II health sector program aims to increase facility deliveries from 50% to 80% from 2015-2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who robustly prefer home births to facility births even after completing 4+ ANC visits. Ebiotishu Oondomonok Ongera (EbOO) is a program in Nainokanoka ward to promote facility births through a care-group model using trained traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for delivery. A qualitative study was conducted to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver. METHODS: In-depth interviews, focus group discussions and key-informant interviews were conducted with 24 pregnant and/or parous women, 24 TBAs, 3 nurse midwives at 3 health facilities, and 24 married men, living in Nainokanoka ward. Interviews and discussions were transcribed, translated, and analyzed thematically using a grounded theory approach. RESULTS: Most women interviewed expressed preference for a home birth with a TBA and even those who expressed agency and preference for a facility birth usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery. TBAs report support for facility deliveries but in practice use them as a last resort, and a significant trust gap was documented based on a bad experience at a facility where women in labor were turned away. CONCLUSIONS: EbOO project data and study results show a slow but steady change in norms around delivery preference in Nainokanoka ward. Gaps between expressed intention and practice, especially around ‘unexpected labor’ present opportunities to accelerate this process by promoting birth plans and perhaps constructing a maternity waiting house in the ward. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services, and increased sensitivity to women’s cultural preferences, could also close the gap between the number of women who are currently using facilities for ANC and those returning for delivery.
Figure 1
Figure 2