Barriers and facilitators to facility-based delivery in rural Zambia: a qualitative study of women’s perceptions after implementation of an improved maternity waiting homes intervention
Objectives Women in sub-Saharan Africa face well-documented barriers to facility-based deliveries. An improved maternity waiting homes (MWH) model was implemented in rural Zambia to bring pregnant women closer to facilities for delivery. We qualitatively assessed whether MWHs changed perceived barri...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-07-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e058512.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832576617515319296 |
|---|---|
| author | Peter C Rockers Godfrey Biemba Davidson H Hamer Nancy A Scott Jeanette L Kaiser Taryn Vian Rachel M Fong Thandiwe Ngoma Jody R Lori Michelle Munro-Kramer Misheck Bwalya Gertrude Musonda Eden Ahmed Mdluli Viviane Rutagwera Sakanga Kayla J Kuhfeldt |
| author_facet | Peter C Rockers Godfrey Biemba Davidson H Hamer Nancy A Scott Jeanette L Kaiser Taryn Vian Rachel M Fong Thandiwe Ngoma Jody R Lori Michelle Munro-Kramer Misheck Bwalya Gertrude Musonda Eden Ahmed Mdluli Viviane Rutagwera Sakanga Kayla J Kuhfeldt |
| author_sort | Peter C Rockers |
| collection | DOAJ |
| description | Objectives Women in sub-Saharan Africa face well-documented barriers to facility-based deliveries. An improved maternity waiting homes (MWH) model was implemented in rural Zambia to bring pregnant women closer to facilities for delivery. We qualitatively assessed whether MWHs changed perceived barriers to facility delivery among remote-living women.Design We administered in-depth interviews (IDIs) to a randomly selected subsample of women in intervention (n=78) and control (n=80) groups who participated in the primary quasi-experimental evaluation of an improved MWH model. The IDIs explored perceptions and preferences of delivery location. We conducted content analysis to understand perceived barriers and facilitators to facility delivery.Setting and participants Participants lived in villages 10+ km from the health facility and had delivered a baby in the previous 12 months.Intervention The improved MWH model was implemented at 20 rural health facilities.Results Over 96% of participants in the intervention arm and 90% in the control arm delivered their last baby at a health facility. Key barriers to facility delivery were distance and transportation, and costs associated with delivery. Facilitators included no user fees, penalties for home delivery, desire for safe delivery and availability of MWHs. Most themes were similar between study arms. Both discussed the role MWHs have in improving access to facility-based delivery. Intervention arm participants expressed that the improved MWH model encourages use and helps overcome the distance barrier. Control arm participants either expressed a desire for an improved MWH model or did not consider it in their decision making.Conclusions Even in areas with high facility-based delivery rates in rural Zambia, barriers to access persist. MWHs may be useful to address the distance challenge, but no single intervention is likely to address all barriers experienced by rural, low-resourced populations. MWHs should be considered in a broader systems approach to improving access in remote areas.Trial registration number NCT02620436. |
| format | Article |
| id | doaj-art-62a3dffecf194b98bf518cd5befa773e |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-62a3dffecf194b98bf518cd5befa773e2025-01-31T04:10:12ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-058512Barriers and facilitators to facility-based delivery in rural Zambia: a qualitative study of women’s perceptions after implementation of an improved maternity waiting homes interventionPeter C Rockers0Godfrey Biemba1Davidson H Hamer2Nancy A Scott3Jeanette L Kaiser4Taryn Vian5Rachel M Fong6Thandiwe Ngoma7Jody R Lori8Michelle Munro-Kramer9Misheck Bwalya10Gertrude Musonda11Eden Ahmed Mdluli12Viviane Rutagwera Sakanga13Kayla J Kuhfeldt141 Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USAPediatric Centre of Excellence, National Health Research Authority, Lusaka, ZambiaDepartment of Global Health, Boston University School of Public Health, Boston, Massachusetts, USAGlobal Health, Boston University School of Public Health, Boston, Massachusetts, USAGlobal Health, Boston University School of Public Health, Boston, Massachusetts, USAUniversity of San Francisco - School of Nursing and Health Professions, San Francisco, California, USAGlobal Health, Boston University School of Public Health, Boston, Massachusetts, USAResearch, Right to Care Zambia, Lusaka, ZambiaSchool of Nursing, University of Michigan, Michigan, Ann Abbor, USAHealth Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USAmothers2mothers, Lusaka, ZambiaAfricare Zambia, Lusaka, ZambiaProject Hope, Bethesda, Maryland, USAProgrammes, Amref Health Africa, Lusaka, ZambiaGlobal Health, Boston University School of Public Health, Boston, Massachusetts, USAObjectives Women in sub-Saharan Africa face well-documented barriers to facility-based deliveries. An improved maternity waiting homes (MWH) model was implemented in rural Zambia to bring pregnant women closer to facilities for delivery. We qualitatively assessed whether MWHs changed perceived barriers to facility delivery among remote-living women.Design We administered in-depth interviews (IDIs) to a randomly selected subsample of women in intervention (n=78) and control (n=80) groups who participated in the primary quasi-experimental evaluation of an improved MWH model. The IDIs explored perceptions and preferences of delivery location. We conducted content analysis to understand perceived barriers and facilitators to facility delivery.Setting and participants Participants lived in villages 10+ km from the health facility and had delivered a baby in the previous 12 months.Intervention The improved MWH model was implemented at 20 rural health facilities.Results Over 96% of participants in the intervention arm and 90% in the control arm delivered their last baby at a health facility. Key barriers to facility delivery were distance and transportation, and costs associated with delivery. Facilitators included no user fees, penalties for home delivery, desire for safe delivery and availability of MWHs. Most themes were similar between study arms. Both discussed the role MWHs have in improving access to facility-based delivery. Intervention arm participants expressed that the improved MWH model encourages use and helps overcome the distance barrier. Control arm participants either expressed a desire for an improved MWH model or did not consider it in their decision making.Conclusions Even in areas with high facility-based delivery rates in rural Zambia, barriers to access persist. MWHs may be useful to address the distance challenge, but no single intervention is likely to address all barriers experienced by rural, low-resourced populations. MWHs should be considered in a broader systems approach to improving access in remote areas.Trial registration number NCT02620436.https://bmjopen.bmj.com/content/12/7/e058512.full |
| spellingShingle | Peter C Rockers Godfrey Biemba Davidson H Hamer Nancy A Scott Jeanette L Kaiser Taryn Vian Rachel M Fong Thandiwe Ngoma Jody R Lori Michelle Munro-Kramer Misheck Bwalya Gertrude Musonda Eden Ahmed Mdluli Viviane Rutagwera Sakanga Kayla J Kuhfeldt Barriers and facilitators to facility-based delivery in rural Zambia: a qualitative study of women’s perceptions after implementation of an improved maternity waiting homes intervention BMJ Open |
| title | Barriers and facilitators to facility-based delivery in rural Zambia: a qualitative study of women’s perceptions after implementation of an improved maternity waiting homes intervention |
| title_full | Barriers and facilitators to facility-based delivery in rural Zambia: a qualitative study of women’s perceptions after implementation of an improved maternity waiting homes intervention |
| title_fullStr | Barriers and facilitators to facility-based delivery in rural Zambia: a qualitative study of women’s perceptions after implementation of an improved maternity waiting homes intervention |
| title_full_unstemmed | Barriers and facilitators to facility-based delivery in rural Zambia: a qualitative study of women’s perceptions after implementation of an improved maternity waiting homes intervention |
| title_short | Barriers and facilitators to facility-based delivery in rural Zambia: a qualitative study of women’s perceptions after implementation of an improved maternity waiting homes intervention |
| title_sort | barriers and facilitators to facility based delivery in rural zambia a qualitative study of women s perceptions after implementation of an improved maternity waiting homes intervention |
| url | https://bmjopen.bmj.com/content/12/7/e058512.full |
| work_keys_str_mv | AT petercrockers barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT godfreybiemba barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT davidsonhhamer barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT nancyascott barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT jeanettelkaiser barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT tarynvian barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT rachelmfong barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT thandiwengoma barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT jodyrlori barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT michellemunrokramer barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT misheckbwalya barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT gertrudemusonda barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT edenahmedmdluli barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT vivianerutagwerasakanga barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention AT kaylajkuhfeldt barriersandfacilitatorstofacilitybaseddeliveryinruralzambiaaqualitativestudyofwomensperceptionsafterimplementationofanimprovedmaternitywaitinghomesintervention |