Pregnant Women Perceived Community Acceptance for Deliveries attended by Traditional Birth attendants and its Correlates in Ethiopia: Community based longitudinal follow up Study

doi:10.21203/rs.3.rs-4138407/v1

Download PDF

Research Article

Pregnant Women Perceived Community Acceptance for Deliveries attended by Traditional Birth attendants and its Correlates in Ethiopia: Community based longitudinal follow up Study

https://doi.org/10.21203/rs.3.rs-4138407/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

World health organization (WHO) recommends that all child birth need to attend by professional skilled attendant who at least midwifery skill through the safe motherhood initiative. Many births in developing are being attended by Traditional birth attendants mainly due women and community acceptance of TBA as sole birth attendants. Therefore, measuring the women perceived community acceptance towards births attended by TBA and identifying factors provides evidence for policy makers, health program managers and health care practitioners in their effort to escalate skilled and facility delivery there by improving maternal and new born health outcome.

Methods

This study used PMA cohort 1 baseline data which enrolled and collected data from currently pregnant women. Frequency was computed to describe the study participant’s characteristics. Multinomial logistics regression was employed to identify correlates of perceived acceptance for births attended by TBA. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05.

Results

One fourth, nearly one in five (18.27%) and 15.05% of the pregnant women reported few people, most and some people in their community think it’s acceptable to deliver with Traditional Birth Attendants (TBA) respectively. attending primary education increases the likelihood of women pregnant women perception that most people in their community thinks that it’s acceptable for deliveries to be attended by TBA. While pregnancy desire that women who intended to have another child have higher likelihood to perceive that few people in their community consider that its acceptable that deliveries to be attended by TBA. On the contrary, religion, residing in the well to HHs, residing in the former SNNP and Addis Ababa have lowered pregnant women perception that people (most, few and some) in their community considers that it’s acceptable for deliveries to be attended by TBA.

Conclusions

Substantially greater proportion of pregnant women reported that it’s acceptable to delivery for at least few people in their community which call on tremendous work to be done to avert such high level pregnant women acceptance that people in their community thinks births to be attended by TBAs. Activities targeting improving women economic status and empowerment; increasing women enrollment to secondary and higher education; using religious leaders and institutions to promote health service use and skilled delivery are likely to mitigate such huge surge of miss conception towards delivery care.

Epidemiology

Women Health

Traditional Birth Attendant

Ethiopia

Deliveries

PMA

The world health organization (WHO) recommends that all child birth need to attend by professional skilled attendant who posed at least midwifery skill through the safe motherhood initiative. (1, 2). Currently, traditional birth attendants (TBA) role is changed to bridging the gap by linking with the formal health system, since they have power and opportunity to convince expectant pregnant women to use the modern health system to seek skilled deliver delivery care at health facilities (3–5).

Pregnancy and child birth is a natural process which is expected to be joyful to the expectant mother and her family (6). Unfortunately, in reality many pregnancies are completed and end up with poor maternal and fetal outcome in many part of the world, notably in low and middle income (2). Moreover, 50% of births in Ethiopia are happening outside of the facility and one recent studies reported that the proportion of births attended by TBA ranges from 31.5% in Angela Tara district (7) to the maximum births attended by TBA reported in in the current South central region, Kembata Tmebaro area was 78% (8). Though an intervention study in Pakistan showed that trained traditional attendants reduce maternal and perinatal mortality (9) other study tend also report the effect of traditional birth attendants as a direct birth attendant is minimal particularly in setting where transportation and other referral linkage inputs are poor (10).

One of the reasons for such high level of births attended by TBA and subsequent negative maternal and newborn fetal outcome is the occurrence of deliveries outside of the health facility, majority of which are attended by traditional birth attendants (TBA) which is largely due to women persistent preference for TBA since women and people in their community perceived the delivery care provide by TBAs is culturally accepted and the direct and indirect cost of facility delivery (8, 11, 12). Women also reported poor quality of care and previous negative experiences with health facilities for not receiving skilled delivery care (8). Such a preference is being affected by a basket full of factors: Women individual characteristics, facility side factors and the influence of significant others. Pregnancy and child birth has a major social dimension (13). women positive attitude (7) is one factor that favor delivery to be attended by TBA.

To this end, community acceptance of TBA as professional birth attendant is reported as on bottleneck that hinder facility deliver service use (1, 12) in particular and health service utilization in general not well explored despite its contribution for such high women TBA preference as and associated impact on fetal and maternal outcome while a study (8) reported that women perception of TBAs as culturally acceptable (14) and competent community health workers is one thematic factor (8) for not using skilled attendant and rather prefer home delivery in Ethiopia which exacerbate the poor pregnancy and delivery outcomes (10, 14).

Women perceived acceptance that people in their community thinks are in favor of births attended by TBA is less explored bottleneck that need further investigation to improve maternal and fetal outcome by promoting facility delivery and using TBAs as a link players (3, 5) rather than considering TBAs as preferred birth attendants. Such a perception might have profound effect on the health of the expectant mother and their newborn when it is held by pregnant women. Hence, documenting the level of pregnant women preconceived acceptance that people in their community thinks that its acceptable for births to be attended by TBA and identifying its correlates thereby producing actionable evidence to improve maternal and newborn by improving facility and skilled delivery care. Therefore, measuring the women perceived community acceptance towards births attended by TBA and identifying factors provides policy makers, health program managers and health care practitioners to escalate skilled and facility delivery there by improving maternal and new born health outcome and improve TBA play their new role acting as doulas. It also provides evidence to integrate TBA´s effort with the health system in the process of providing skilled birth care and facility delivery.

Study Design and Population and Sample Size

Cohort 1 panel baseline data was used for this study. All pregnant women with gestational age of 1 to 9 months by the time of data collection for whom female baseline and household forms were completed included in this analysis, hence, a total of 2868 pregnant women were included in this analysis. The overall sample size and cell sample size adequacy was checked and found adequate to generating unbiased estimates.

Data collection and Field Work.

Cohort 1 baseline data was collected from November to December 2019. The details in field work implementation is reported elsewhere (15). The first field work of the pane baseline survey was screening pregnant women and women who were less than 6 weeks post-partum. A two stage stratified cluster sampling method was used to select enumeration areas. Complete census was conducted in the selected enumeration areas followed by selection of 35 households per enumeration area using simple random sampling. It was executed by Addis Ababa University’s School of Public Health in collaborative efforts with the Ethiopian Public Health Association with assistance from the Federal Ministry of Health, Central Statistical Agency, Bill & Melinda Gates Institute for Population and Reproductive Health (Johns Hopkins Bloomberg School of Public Health), and the source of funding is from Bill & Melinda Gates Foundation. The main sample units or enumeration areas (EAs) were chosen using the frame to Ethiopia Population and Housing Census (PHC), which was performed in 2019 by the Ethiopia Central Statistical Agency. A total of 162 EAs were chosen in the first stage, with Independent selection in each sample stratum and a probability proportional to EA size. All pregnant women between the ages of 15 and 49 who were either long-term residents of the chosen households or who come to deliver there they were screened using enrollment criteria and those found eligible were consented to participate in the baseline line interview. The protocol Of PMA Ethiopia contains all the details on sample design and selection methods. More detail in the details on sampling design and selection procedures and field work implementation was described well elsewhere (15).

Variables:

Outcome variable

The main outcome variable was traditional birth attendant (TBA) Norm which was measured by asking the respondent a single question with four scales no, few, some and most people: how many people in their community thinks that it’s acceptable to deliver by TBA. If the pregnant women reported as 0 people thinks she was considered no people in her community this that it’s acceptable to deliver with TBA. A women who reported some, few or more people think that it’s acceptable to delivery by TBA were considered as at least few/some people think that is acceptable to for the birth to be attended by TBA (Table 1). The outcome variable is treated as nominal variable with more than two categories, hence, multinomial logistics regression is appropriate for the analysis.

Table 1

Items used to create the pregnant women Community acceptance that few, some or most people in their community thinks it’s acceptable to deliver by Traditional birth attendant, PMA Cohort 1 Baseline survey data, and 2019 to 21
Do X people in your community thinks it’s acceptable to deliver with Traditional Birth Attendant (TBA)	Variable	Question & Responses		Categories
		Item	Response
	TBA NORM		Do not know =-88	Excluded
			Most people thinks = 0	Most people thinks = 0 Most people thinks =1 Some people thinks = 2 Few People Think = 3
			Most people thinks =1
			Some people thinks = 2
			Few People Think = 3

Independent Variables

Independent variables were classified into individual-level variables and enumeration area-level variables. Individual-level independent variables further categorized into socio-demographic/economic characteristics variables, parity and other RH characteristics, couples reaction when they learned that they were pregnant and contraception ever use were considered in the study.

Group or enumeration area (EA) level variables included two integral variables namely, region and place of residence were considered. “Region” was grouped into four categories 3 = Amhara, 4 = Oromia, 7 = SNNPRs and 10 = Addis Ababa city administration. Place of residence follows the default urban/rural classification.

Analysis and Measurement

The panel baseline women data set was used for this analysis. Stata v16 was used for this analysis. Frequencies and percentages were computed to characterize the study population. Chi-square test statistics was computed to check cell sample size adequacy and the sample size was found to be adequate to provide unbiased estimates.

Exploratory data analysis was run for data cleaning thereby checking item nonresponse rate for every variable and don’t know response which were later excluded from the analysis. Following this variable were recoded to create biological plausible categories along with checking distribution of the recoded variables using mean and proportion. No sign of multicollinearity detected among variables in the final model.

Multinomial logistics regression was used to identify important predictors for pregnant women perceived community acceptance on deliveries to be attended by Traditional Birth Attendants. At bivariate analysis a p value cut of 0.25 was used to select candidate variable for multilevel multivariable logistics regression analysis. Results were presented in the form of percentage, and odds ratio with 95% CI. Significance was declared at a significance level of 0.05. Results were reported based on weighted count. Model fitness test was checked using the command «mlogitgof» and the result shown that the model is fit meaning that variables included in the final multilevel multinomial logistics regression model explains for the variation in the women decision making on her family planning use. This supported by the model fitness test result; p value = 0. 737 with a chi-square statistics of 19.274.

Data Quality Management and Control

Data completeness for variables and items for creating composite variables was checked by exploratory data analysis following which any item nonresponse was excluded from the analysis. Frequency run to exclude responses with do not know (DNK) and no response (NR).

PMA Ethiopia used of standard and pretested tool, intensive training with mock interviews for resident enumerators was provided, close supervisor during filed work, timely progress report and correction, 10% random check were some of the modalities used to maintain the quality of the collected data, the detail is reported somewhere else (15).

Participants Characteristics

Magnitude of Perceived Community thinking on Acceptance of delivering with TBA

One fourth, nearly one in five (18.27%) and 15.05% of women reported few people, most and some think it’s acceptable to deliver with TBA respectively. One in 6 women of the surveyed women reported that at least few people in their community think it’s acceptable to deliver with Traditional Birth Attendants (TBA). On the contrary one in 4 (41.36%) of the surveyed women reported that no people in their community thinks it’s acceptable to delivery by TBA (Fig. 1).

Table 2: Distribution of Pregnant Women Perceived acceptance that few, some and most people in their Community thinks it acceptable for Births Attended By Traditional Birth Attendant (TBA), Evidence from PMA Cohort One, 2019 to 21 (n=2,868)

Variable	No People	%	Most People	%	Some People	%	Few People	%	Total
15–19 years	94	30.89	76	24.89	58	19.17	76	25.06	304
20–24 years	284	42.82	116	17.53	97	14.71	165	24.94	662
25–29 years	387	46.12	141	16.83	111	13.28	199	23.77	839
30–34 years	200	38.26	94	18.05	83	15.92	145	27.77	523
35–39 years	149	41.88	61	17.09	47	13.31	99	27.73	355
40–49 years	46	38.48	24	20.16	24	20.30	25	21.07	119
Total	1159	41.36	512	18.27	422	15.05	709	25.32	2802
No_Formal_Education	432	37.32	257	22.20	177	15.31	291	25.17	1157
Primary Education	427	37.89	199	17.64	192	17.07	309	27.41	1126
Secondary+_Education	300	57.91	56	10.87	52	10.10	110	21.12	519
Total	1159	41.36	512	18.27	422	15.05	709	25.32	2802
Other	13	22.55	21	36.23	12	20.09	12	21.14	58
Orthodox	498	46.52	174	16.29	145	13.51	254	23.67	1071
Protestant	264	36.18	107	14.72	124	17.00	234	32.11	730
Muslim	384	40.66	209	22.17	141	14.98	209	22.19	943
Total	1159	41.36	512	18.27	422	15.05	709	25.32	2802
Lowest quintile	148	26.25	134	23.72	106	18.69	177	31.34	565
Lower quintile	187	33.27	106	18.84	111	19.80	158	28.08	561
Middle quintile	210	37.10	113	19.94	89	15.72	154	27.23	565
Higher quintile	256	45.31	113	20.04	81	14.29	115	20.36	566
Highest quintile	358	65.65	46	8.46	35	6.48	106	19.41	545
Total	1159	41.36	512	18.27	422	15.05	709	25.32	2802
No Child	225	43.57	86	16.59	77	14.86	129	24.98	517
1_2 Children	475	46.35	162	15.79	139	13.55	249	24.31	1025
3_12 Children	458	36.39	263	20.95	206	16.36	331	26.30	1258
Total	1158	41.36	511	18.25	421	15.05	709	25.33	2799
Only Once	991	41.29	448	18.66	373	15.54	589	24.51	2401
Morethan_Once	156	41.68	56	15.03	46	12.33	116	30.96	373
Total	1147	41.34	504	18.17	419	15.11	704	25.38	2774
No	1043	42.14	437	17.64	371	15.00	624	25.22	2475
Yes	81	32.38	60	24.16	39	15.55	70	27.92	249
Total	1124	41.25	497	18.24	410	15.05	694	25.47	2724
Undecided	91	44.37	39	19.26	42	20.67	32	15.69	204
Wanted another child	631	41.14	271	17.67	210	13.69	422	27.50	1535
No more another child	180	39.89	82	18.13	77	17.11	112	24.88	450
Total	902	41.19	392	17.91	329	15.04	566	25.86	2189
Variable	No People	%	Most People	%	Some People	%	Few People	%	Total
Never Married+	27	46.16	12	20.21	8	14.01	12	19.62	59
Married	1080	40.56	493	18.52	404	15.18	685	25.74	2663
Living With a Partner	50	64.10	7	8.94	8	10.53	13	16.44	78
Total	1157	41.34	512	18.29	421	15.02	710	25.35	2800
No	372	34.08	247	22.69	177	16.21	295	27.02	1091
Yes	787	45.99	264	15.46	245	14.31	415	24.24	1710
Total	1158	41.35	512	18.27	422	15.05	709	25.32	2801
Urban	402	65.80	41	6.63	55	8.96	114	18.62	611
Rural	757	34.54	471	21.52	367	16.75	596	27.19	2191
Total	1159	41.36	512	18.27	422	15.05	709	25.32	2802
Tigray	71	36.44	51	26.18	22	11.33	51	26.05	196
Afar	7	11.68	37	65.83	8	13.44	5	9.06	56
Amhara	277	49.37	83	14.72	69	12.39	132	23.52	561
Oromia	424	34.37	271	21.99	235	19.07	303	24.56	1234
SNNP*	291	44.65	65	9.95	84	12.92	212	32.48	652
Addis Ababa	89	85.80	5	4.86	3	2.85	7	6.49	104
Total	1159	41.36	512	18.27	422	15.05	709	25.32	2802
No partner	38	33.07	21	17.78	29	25.49	27	23.67	116
Very unhappy	26	43.32	12	20.66	6	9.25	16	26.77	60
Sort of unhappy	40	31.67	24	18.78	25	19.67	38	29.88	126
Mixed happy-unhappy	76	34.64	36	16.34	44	19.83	64	29.18	220
sort of happy	387	43.42	161	18.01	124	13.95	219	24.61	891
Very happy	580	44.07	234	17.77	185	14.04	317	24.12	1316
Total	1147	42.04	487	17.85	413	15.12	682	25.00	2729
Very happy	530	44.21	210	17.49	176	14.72	283	23.58	1199
Sort happy	305	43.10	118	16.66	102	14.44	183	25.81	708
Mixed unhappy	161	37.57	90	21.04	66	15.37	112	26.01	430
Sort unhappy	83	36.14	37	16.12	39	17.07	71	30.67	230
Very unhappy	72	33.21	50	23.23	35	16.35	59	27.21	216
Total	1152	41.38	505	18.16	419	15.07	707	25.39	2783
No One/ND	21	16.87	19	15.09	30	24.43	54	43.61	124
HP	734	51.62	144	10.14	178	12.53	365	25.70	1422
TBA/Family Member	145	22.59	229	35.78	120	18.73	147	22.90	640
Family Member	129	34.79	101	27.19	61	16.47	80	21.54	371
Total	899	41.15	392	17.94	328	15.02	566	25.89	2186
Home/ND	182	22.58	260	32.22	157	19.47	208	25.74	808
Government HF	719	52.08	132	9.54	172	12.45	358	25.93	1381
Total	902	41.19	392	17.91	329	15.04	566	25.86	2189

*former SNNPR region

Distribution of Pregnant Women Perceived Community Acceptance on Births Attended By Traditional Birth Attendant (TBA)

Pregnant women perception on how many people in their community thinks that it’s acceptable for births attend by TBA show variation by the selected independent variables. Accordingly, one in 6 Pregnant women that aged 20 to 24 (17.53%) and 35 to 39 years (17.09%) perceived that most people in their community thinks that is acceptable to deliver with TBA while nearly one in 4 pregnant women aged 15 to 19 perceived that few people considers its acceptable. The percentage of pregnant women who perceived most, some and few people in their community 17.64%, 17.07% and2741% respectively among those who attended primary education. There is variation in the proportion pregnant women who perceived most, some and few people in their community considers that it’s acceptable for births to be attended by TBA. For instance the respective proportion for Muslim religion followers is 22.17%, 14.98% and 22.19% respectively. This same figure is 19.52%, 15.18% and 25.74% for most, some and few people in their community among currently married women. (Table 2).

Similarly, among those who have higher birth orders, 18.25%, 15.05% and 25.33% of the pregnant women considers that its acceptable for births to be attended TBA by most, some and few people in their community. Likewise pregnant women who wanted to have another child perceived that 17.67%, 13.69% and 27.5% of most, some and few people in their community considers it’s acceptable for births to be attended by TBA. Likewise the variation that pregnant women perceived acceptance that births need to be attended for contraceptive ever users is 24.16% for most people, 15.55% and 27.92 for some and few people in their community respectively (Table 2).

In similar fashion, the variation in pregnant women perceived acceptance is observed by the wealth index of the HH in which the women resides. Accordingly, 1 in 5 women from the well to do HHs perceived that most and few people in their community its thinks that it’s acceptable for births to be attended by TBA while 14.29% for some people. Likewise pregnant women who reside in rural areas perceived that 21.52%, 16.75% and 27.19% of most, some and few people in their community considers it’s acceptable for births to be attended by TBA (Table 2).

Pregnant women who reside in Tigray, 1 in 4 women (26.18% for most and 26.05 for few people) think that it’s acceptable for births to be delivered by TBA in their community and few while 11.33% for some people. This same figure for pregnant women residing in Oromia region stands 21.99%, 19.07% and 24.56% for most some and few people in their community respectively (Table 2).

In terms of desired attendant 10.14%, 12.53% and 25.7% of pregnant women perceived that most, some and few people thinks that it’s acceptable for births to be attended by TBAs. For Desired place of delivery this same figure for most, some and few people in their community to be perceived to accept births attended by TBA is 9.54%, 12.45% and 25.93% respectively (Table 2).

Correlates Perceived Community Acceptance on Births Attended By Traditional Birth Attendant (TBA) among Pregnant Women, Evidence from PMA Cohort One Survey, 2019 to 21

In summary, this study attempted to factors influencing pregnant women perceived acceptance for most, some and few peoples in their community to think that it’s acceptable for births to be attended by TBAs. Accordingly, educational status increase the likelihood of pregnant women perceived acceptance for births attended by TBAs by most people while having fertility desire to another child increases the likelihood of few people in their the pregnant women community to think that its acceptable for births to be attended by TBAs (Table 3).

Pregnant women with primary educational status had 1.516 (1.056, 2.173) higher likelihood of perceived acceptance for most people in their community. Similarly Fertility desire wanted another child increase 1.607 (1.013, 2.549) for pregnant women acceptance on few people thinks that it’s acceptable to deliver via TBAs (Table 3).

On the contrary, living in the well to do households and residing in SNNPR and Addis Ababa regions reduce the odds of pregnant women to perceive most, some and few people in their community considers that its acceptable foe births attended by TBAs. Similarly followers Muslim and religion as well as pregnant whose desired place of deliver is health facility had reduce likelihood of perceiving that for most people in their community its acceptable for births to be attended by TBAs. Likewise for few pregnant women their likelihood to perceive few people in their community to think that it’s acceptable for babies to be delivered by TBAs (Table 3).

Pregnant women perceived acceptance for most in their community peoples to think that it’s acceptable for births to be attended by TBAs is 80% lower for Orthodox Christina religion 0.195 (0.059, 0.643) and Muslim religion 0.175 (0.054, 0.564) followers. Similarly, pregnant women residing in households Higher wealth had a 60% 0.408 (0.253, 0.658), 35% 0.557 (0.335, 0.926) and 57% 0.431 (0.281, 0.659) lowered odds of pregnant women perceived acceptance for most, some and few people in their community to think it’s acceptable to deliver by TBAs respectively (Table 3).

Compared to Tigray the likelihood of pregnant women residing in the former SNNPR 0.047 (0.024, 0.095) and Addis Ababa was found to be 0.043 (0.017, 0.105); 0.301 (0.15 0.593) an 0.091 (0.026, 0.323) and 0.588 (0.359, 0.966) and 0.178 (0.091, 0.35) for most, some and few people in their community respectively

Desire place of deliver: HF decrease 0.337 (0.173, 0.657) for pregnant women’s perceived for most people acceptance that its ok to deliver with help of TBA while compared no one preferred. pregnant women who preferred that their index pregnancy to be attended by HP and TBA/family member reported a lower likelihood of perceived acceptance that few people thinks it ok if a women delivery by TBA 0.268 (0.131, 0.549) and 0.298 (0.155, 0.573) respectively (Table 3).

Table 3

Multinomial Logistic Regression Pregnant Women Perceived Acceptance on Births to be delivered by TBA, Evidence from PMA Cohort 1, 2019 to 2021
Women Age Category	Variables	Most People A RRR	Some People A RRR	Few People, A RRR
	15–19 years	1	1	1
	20–24 years	0.71 (0.41,1.24)	0.66 (0.37,1.17)	1.11 (0.68,1.82)
	25–29 years	0.64 (0.36,1.17)	0.57 (0.30,1.06)*	1.02 (0.60,1.73)
	30–34 years	0.65 (0.33,1.28)	0.68 (0.33,1.40)	1.43 (0.78,2.59)
	35–39 years	0.66 (0.31,1.41)	0.738 (0.335,1.628)	1.12 (0.578,2.16)
	40–49 years	0.66 (0.25,1.74)	1.083 (0.422,2.781)	0.67 (0.28,1.63)
Educational Status	No formal education	1	1	1
	Primary Education	1.52 (1.06,2.17)**	1.30 (0.89,1.89)	1.26 (0.93,1.71)
	Secondary+ _Education	1.13 (0.69,1.86)	1.491 (0.88,2.52)	1.045 (069,1.58)
Religion	Others	1	1	1
	Orthodox	0.2 (0.06,0.64)***	0.36 (0.1,1.28)	0.77 (0.23, 2.63)
	Protestant	0.34 (0.10,1.14)*	0.82 (0.23,2.91)	1.15 (0.34,3.93)
	Muslim	0.178(0.05,0.56)***	0.36 (0.10, 1.28)	0.76 (0.23, 2.60)
Wealth Index	Poorest quintile	1	1	1
	Lower quintile	0.64 (0.40, 1.03)*	0.87 (0.53, 1.42)	0.756 (0.49,1.12)
	Middle quintile	0.63 (0.40, 1.00)*	0.82 (0.50,1.34)	0.57 (0.38,0.86)***
	Higher quintile	0.41 (0.25, 0.66)***	0.56 (0.34,0.93)**	0.43 (0.28,0.66)***
	Highest quintile	0.563 (0.283,1.12)	0.18 (0.09,0.38)***	0.45 (0.25,0.81)***
Parity	No Child	1	1	1
	1_2 Children	0.84 (0.55,1.29)	0.95 (0.59,1.52)	0.90 (0.62, 1.27)
	3_12 Children	0.97 (0.56,1.69)	0.87 (0.471,1.59)	0.76 (0.48. 1.23)
Husband Has other Wifes	NO	1	1	1
Husband Has other Wifes	Yes	1.20 (0.73,1.96)	1.05 (0.62,1.76)	1.05 (0.68, 1.63)
Fertility Desire	Undecided	1	1	1
	Wanted to have another child	0.794 (0.503.1.255)	0.665 (0.412,1.073)*	1.61 (1.01,2.55)**
	No more to have another child	0.675 (0.39,1.169)	0.753 (0.431, 1.314)	1.39 (0.83,2.35)
Contraceptive Ever Use	No	1	1	1
Contraceptive Ever Use	Yes	0.97 (0.71,1.38)	0.84 (0.59,1.19)	0.82 (0.92,1.085)
Residence	Urban	1	1	1
Residence	Rural	1.46 (0.85,2.52)	0.83 (0.49,1.39)	1.54 (0.99,2.40)*
Region	Tigray	1	1	1
	Afar	1.41 (0.65,3.07)	2.49 (1.04,5.96)**	0.96 (0.42,2.17)
	Amhara	0.17 (0.11, 0.27)***	0.59 (0.34,1.03)*	0.69 (0.45,1.06)*
	Oromiya	0.18 (0.11,0.30)***	0.979 (0.554,1.729)	0.83 (0.53,1.29)
	SNNP	0.05 (0.02,0.09)***	0.30 (0.15,0.59)***	0.59 (0.36,0.97)**
	Addis	0.04 (0.02,0.11)***	0.09 (0.03,0.32)***	0.18 (0.091,0.35)***
Desired Delivery Place	Home	1	1	1
Desired Delivery Place	Health Facility	0.34(0.17,0.66)***	0.59 (0.29,1.20)	0.81 (0.48,1.46)
Desired Attendant	No one	1	1	1
	HP	0.84 (0.32.2.20)	0.46 (0.191,1.12)*	0.27 (0.13,0.55)***
	TBA/Family Member	2.07 (0.88,49)*	0.55 (0.25,1.17)	0.30 (0.16,0.57)***

*** p < .01, ** p < .05, * p < .1

Maternal and new born health outcome can be greatly improved with cost effective intervention among others skilled birth attendant plays pivotal role. Unfortunately, in the SDG era women still prefer their births to be attended by TBAs outside of the health facility. Evidences showed that one of the bottlenecks for such huge surge is women perception that people in their community considers it’s acceptable for births attended by TBAs. Therefore, in the midst of the SDG era and at this time when modern health service is being available and accessible to a larger extents; and the government of Ethiopia is very committed to provide delivery service with exemption from payment; documenting the proportion pregnant women who perceived that for people in their community its acceptable for Births to be delivered by TBA and identifying its correlates for the variation for such an acceptance is very critical in availing actionable evidence to improve maternal and new born outcome by increasing skilled delivery care at health facilities.

This study identified both positive and negative correlates of pregnant women to perceive at least few people in their community thinks that it’s acceptable for deliveries to be assisted by TBAs.

Accordingly, Educational status, i.e. this study found out that attending primary education increases the likelihood of pregnant women perception that most people in their community thinks that it’s acceptable for deliveries to be attended by TBA. While pregnancy desire that currently pregnant women who intended to have another child have higher likelihood to perceive that few people in their community consider that its acceptable that deliveries to be attended by TBA. The perceived acceptance of less educated pregnant women that most people in their community thinks that its acceptable for births to be attended by TBA can be related with low awareness on complication of pregnancy and child health and misconception that women with complication alone need professionally assisted delivery as stated (12): A number of respondents reported that trained delivery attendants or an institutional delivery were only aimed at women who experienced obstetric complications (12, 14, 17). This might be also related with the TBAs cultural and social acceptability (13). The finding that pregnant women who intends to have another child had a higher likelihood perceived acceptance that few people in their community thinks that its acceptable for babies to be delivered by TBAs might be related confidence developed since they have pregnancy and child bearing experience (6, 13).

On the contrary, religion, residing in the well to HHs, residing in the former SNNP and Addis Ababa were correlates found to lower pregnant women perception that people (most, few and some) in their community considers that it’s acceptable for deliveries to be attended by TBA. This might be due to that pregnant women residing in well to do HH has the opportunity and potential to plan for their deliveries to be attended by skilled birth attendance at health facilities (6, 8, 17). Living in a well to do house hold is likely to empower women on decision making with respect to utilization of health services thereby being prepared for their pregnancy and delivery and women tend to held low perceived community acceptance for births to be delivered by TBA (18, 19).

Similarly, pregnant women who reported that they follow Muslim and orthodox religion and whose desired place of delivery was health facility had lower likelihood towards perceiving that most people in their community thinks it is acceptable for deliveries to be attended by TBAs. The influence of religion and culture on pregnancy and child bearing in general and women perceived acceptance to their community people thought that they think it ok if births are attended by TBA is reflected in previous similar studies (13, 14, 17). Last but not least pregnant women whose desired birth attendant was Health professionals reported a lower likelihood of perceiving that few people in their community considered that it’s acceptable for births to be attended by TBAs.

The finding that 1 in 6 women reported that they perceived at least for some people in their community that it ok for deliveries to be attended by TBA substantially impact maternal and new born health outcome negatively which call up on awareness creation and community campaign to reverse this skewed perception.

Activities targeting improving women economic empowerment, increasing women enrollment to secondary and higher education, using religious leaders and institution to promote health service use and skilled delivery are likely to mitigate such huge surge miss conception. Improving health care service to be friendly and accessible including hiring high level health profession like in as practiced in bigger cities contribute such high level preference of TBAs.

ARRR

adjusted relative risk ration

CRRR

crude relative risk ration

house holds

SNNPR

Southern nations, people’s nationalities Region

TBA

Traditional birth attendants

Ethics approval and consent to participate:

This study involved a secondary analysis of deidentified data from the PMA Ethiopia. The PMA Ethiopia survey was conducted strictly under the ethical rules and regulations of world health organization and IIRB of Ethiopian Health and Nutrition Research Institute (EHNRI). Informed consent was obtained from respondents during the data collection process of PMA Ethiopia on the baseline data collection on Oct 2021. PMA surrey has been also conducted after obtained ethical approval from Bloomberg School of Public Health at Johns Hopkins University in Baltimore, USA.

Consent for publication: N/A not applicable

Availability of data and materials: The datasets generated during the study are publicly available from the PMA website. https://www.pmadata.org/data/request-access-datasets.

Competing interests: the authors declare that they have no competing interest.

Funding: The authors did not obtained any funding.

Authors contribution

SA conceptualized the study, obtained and analyzed the data, wrote the final draft of the manuscript, interpreted the results and critically revised the manuscript. SA also participated in the field wok supervision, implementation and project facilitation. FT contributed to the conception of the idea and interpretation of the results along with critically reviewing the final manuscript. KM contributed in critically reviewing the final manuscript version. All authors reviewed and approved the final manuscript.

Acknowledgement:

The authors would like to pass their acknowledgement for PMA Ethiopia Project for providing the data set through the data lab.

WHO. TRADITIONAL BIRTH ATTENDANTS A field guide to their training, evaluation, and articulation with health services. WHO Offset Publication No 44 (1979) Ajoint WHO/UNFPA/UNICEF Statement. 1992
World Health Organization. Intrapartum care for a positive childbirth experience. [cited 2018 July 23]. Available from:. Geneva: World Health Organization (2018) http://apps.who.int/bookorders. 2018
Kassie A, Wale A, Girma D, Amsalu H, Yechale M (2022) The role of traditional birth attendants and problem of integration with health facilities in remote rural community of West Omo Zone 2021: exploratory qualitative study. BMC Pregnancy Childbirth 22(1):425
Miller T, Smith H (2017) Establishing partnership with traditional birth attendants for improved maternal and newborn health: a review of factors influencing implementation. BMC Pregnancy Childbirth 17(1):365
Margaret E, MacDonald et al (2022) The Place of Traditional Birth Attendants in Global Maternal Health: Policy Retreat, Ambivalence and Return. Chapter 6 L J Wallace (eds), Anthropologies of Global Maternal and Reproductive Health, Global Maternal and Child Health, https://doiorg/101007/978-3-030-84514-8_6
JHPIEGO (2004) monitoring birth preparedness and complication readiness tools and indicators for maternal and newborn health
Taye BT, Zerihun MS, Kitaw TM, Demisse TL, Worku SA, Fitie GW (2022) ea. Women’s traditional birth attendant utilization at birth and its associated factors in Angolella Tara, Ethiopia. PLoS ONE 17(11): e0277504 https://doiorg/101371/ journalpone0277504
Shiferaw et al (2013) Why do women prefer home births in Ethiopia? 2013; BMC Pregnancy and Childbirth. 13:5http://www.biomedcentral.com/1471-2393/13/5
Abdul Hakeem Jokhio et (2005) ai. An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan. n engl j med 352;20 wwwnejmorg may 19, 2005
Gurara M, Muyldermans K, Jacquemyn Y, Van Geertruyden JP, Draulans V (2020) Traditional birth attendants' roles and homebirth choices in Ethiopia: A qualitative study. Women Birth 33(5):e464–e72
Garces A, McClure EM, Espinoza L, Saleem S, Figueroa L, Bucher S et al (2019) Traditional birth attendants and birth outcomes in low-middle income countries: A review. Semin Perinatol 43(5):247–251
Titaley et al (2010) Why do some women still prefer traditional birth attendants and home delivery? a qualitative study on delivery care services in West Java Province, Indonesia. BMC Pregnancy and Childbirth. 10:43 http://wwwbiomedcentralcom/1471-2393/10/43. 2010
Aynalem ea (2023) 41 http://onlineliebertpubcom/doi/101089/whr20230024. 2023
Aziato and Omenyo. Initiation of traditional birth attendants and their traditional and spiritual practices during pregnancy and childbirth in GhanA. BMC Pregnancy and Childbirth (2018) 18:64 https://doiorg/101186/s12884-018-1691-7. 2018
Zimmerman L, Desta S, Yihdego M, Rogers A, Amogne A, Karp C et al (2020) Protocol for PMA-Ethiopia: a new data source for cross-sectional and longitudinal data of reproductive, maternal, and newborn health. ;4
Ntoimo LFC, Okonofua FE (2022) CEe. Why women utilize traditional rather than skilled birth attendants for maternity care in rural Nigeria: Implications for policies and programs. Midwifery 104:103158
Sarker BK, Rahman M, Rahman T, Hossain J, Reichenbach L (2016) Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs) in Rural Bangladesh: A Qualitative Exploration. PLoS ONE 11(1):e0146161. 10.1371/journal.pone.0146161
Sialubanje et al (2015) Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study. BMC Pregnancy and Childbirth 15:216 DOI 101186/s12884-015-0652-7. 2015
Fantaye FT, Damtew SA (2024) Women decision making on use of modern family planning methods and associated factors, evidence from PMA Ethiopia. PLoS ONE 19(2):e0298516. https://doiorg/101371/journalpone0298516

The authors declare no competing interests.

Download PDF

Version 1

posted

You are reading this latest preprint version

Pregnant Women Perceived Community Acceptance for Deliveries attended by Traditional Birth attendants and its Correlates in Ethiopia: Community based longitudinal follow up Study

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

Background

Methods and Data Sources

Result

Discussion

Conclusion

List Of Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1