Abstract
High level of Maternal Mortality Ratio in Nigeria is attributed to low patronage of competent birth attendants. This study aimed to assess the factors influencing home delivery. Studies has shown that women are aware of places of delivery and kind of services provided but majority patronized home delivery. Adoption of home delivery service is associated with factor such as unavailability of health workers, familiarity with service providers, religious beliefs, fear of caesarean section, etc. Factors such as education, number of pregnancies, marital status and parity status has also been found to be associated with home delivery.
Conclusion: Home delivery is influenced by inefficiency (lack of staff and required materials/equipment) associated with primary healthcare, lack of female autonomy and distance to health care facilities.
Keywords: Home delivery, Maternal care, Maternal mortality.
TABLE OF CONTENTS
List of figures
Figure 3.1: The three
delays 7
Global reduction of maternal mortality has been a vital challenge to
public health especially in developing nations. Reduction of maternal morbidity
and mortality is among the Sustainable Development Goals (SDGs) constituted by the United
Nation (UN). It was launched
in 2015 on a 15- year
plan that would come to an end
in the year 2030. Adoption
of SDG 17, Goal 3; “Ensure healthy lives and promote well-being for all at all ages” among the UN member states
continued their global
commitments with the first target to reduce global Maternal Mortality Ratio
(MMR) to less than 70 per 100 000 live births
by 2030 with no country
having more than two times
the global average
(World Health Organization [WHO],
2019). The approximated global MMR for the year 2017 was 211 deaths per 100 000 live births which indicated 38% reduction
since 2000, when it was approximated
at 342 per 100,000 livebirths (WHO, United Nations
Children’s Fund [UNICEF], United Nations Population Fund [UNFPA] & World Bank,
2019). Among the developing countries, an approximated 130,000 maternal deaths
occurred in 2017 with maternal
death risk of 1 in 56 (WHO,
2019). At regional
level, sub-Saharan Africa in 2017 had the highest
MMR, approximated at 542 with maternal death
risk of 1 in 37 as compared to 1 in 7800 for Australia and New Zealand (WHO, 2019).
Nigeria and India recorded the highest rate of maternal deaths accounting
for approximately 35% of the global maternal deaths in 2017 with an estimated
67,000 and 35,000 maternal deaths (23% and 12%
of global maternal
deaths). One of the influencing attributes to high level of MMR in Nigeria is due to the low patronage of competent
birth attendance with 45% of birth delivered by competent health workers
in 2015 and this does not exclude
the kind of facilities where
birth activities occurred (Ishola, & Filippi 2017).
There is a high risk of a woman losing her life due to complications from
childbirth and this has led to about 67,000 mortalities due to childbirth complications annually (Ajah, et al., 2019; WHO, 2019). A pregnant woman
from sub-Saharan Africa
region has 1/37 risk of losing
her life during pregnancy or childbirth while
such risk is 1/7800 in developed nations
which highlights the high level of imbalance
in the level of MMR between developed and developing nations (UNICEF,
2019). A fairly large number of women of
childbearing age in developing nations still deliver their babies at home
without supervision by skilled birth attendants (Ajah, et al., 2019).
The aspect of individual attributes and choice of birth places
cannot be ignored
when considering the rate of maternal mortality in
industrialized nations; such attributes include maternal age, parity,
education, marital status, size of family and level of wealth while community
factors such as socioeconomic status, health infrastructure, terrain, urban/rural
residence, availability of the healthcare centres and distance to the
healthcare facilities (Ravi & Kulasekaran , 2014; Ajah, et al., 2019).
At the global level, below 2% of the childbirth deliveries take place at home
among the developed nations, the only exception among the nation is Netherlands
which allows childbirth delivery at home up to 30% of their total delivery,
while for developing nations, over 50% of their childbirth takes place at home (Sinkamba, 2019). As established by Gabrysch et al.,
(2011) and Kifle, et al., (2018), childbirth that takes place in health facility
under the supervision of competent health personnel is connected with lower rates of maternal
deaths than home delivery. Furthermore, Kifle et al.
(2018) posited that childbirth that takes place
in health facility
play a vital role in forestalling still births and improving new-born
survival.
According to Sinkamba
(2019), childbirth is a “natural
physiological process that any normal
pregnant woman undergoes to deliver the foetus, placenta and its
membranes and other products of conception”.
Based on this, many women find it extremely challenging to come to terms with the fact that delivery is best done at health
facility considering the fact that labour set off gradually whether from home
or at a health facility. Many of the women that went through home deliveries
are surrounded by their relatives and neighbours who had delivered before and
think they have all the required knowledge and experience to take delivery of
others but in reality, they fail to understand that every pregnancy comes with
threat to life for both the mother and unborn child. Pregnancy sometimes has various level
of complication that can cause
harm or death
if not professionally handled
(Sinkamba, 2019). These
complications are beyond the experience and knowledge of the relatives or Traditional Birth Attendant (TBA) to handle
and require the attention of health workers
with scientific understanding
and know-how on such complications. Asides
all these complications and threats to life, the cleanliness of home
environment, the materials involved being free from germs, using the right
methods and ability for such persons to handle complications cannot be
ascertained.
Aim of the study
The aim of this article is to assess the factors
influencing home delivery.
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