TY - JOUR
T1 - Cultural Norms Create a Preference for Traditional Birth Attendants and Hinder Health Facility-based Childbirth in Indonesia and Ethiopia: A Qualitative Inter-country Study
AU - Nasir, Sudirman
AU - Zerihun Kea, Aschenaki
AU - Steege, Rosie
AU - Limato, Ralalicia
AU - Tumbelaka, Patricia
AU - Datiko, Daniel Gemechu
AU - Syafruddin, null
AU - Kok, Maryse
AU - Ahmed, Rukhsana
AU - Taegtmeyer, Miriam
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Cultural barriers to health facility-based childbirth are a common experience worldwide despite wide variations in context. Close-to-community (CTC) maternal health providers play an important role in bridging communities and health systems and their role in maternal health are particularly key. This study explored the views of CTC maternal health providers and other community members on the cultural barriers to health facility-based childbirth in two districts in Indonesia and six districts of Sidama Zone, southern Ethiopia. Employing a qualitative approach, we conducted 110 semi-structured interviews (SSIs) and 7 focus group discussions (FGDs) in Indonesia; 44 SSIs and 14 FGDs in Ethiopia. Participants in both contexts included mothers, husbands, male community members, traditional birth attendants (TBAs), village heads, local administrators, district health officials, maternal health-care workers and CTC maternal health providers. Despite significant geographical and cultural differences, the main findings were similar in the two countries’ study areas. These included: strong cultural-religious beliefs; culture of shyness and privacy around pregnancy; highly gendered decision-making related to pregnancy and childbirth; and preference for the TBA care. TBAs’ close proximity at the time of childbirth and their adherence to traditional practices were important factors influencing preference for TBAs. These cultural barriers interplay with geographical, transportation and financial factors hindering pregnant women from giving birth at a health facility. Intensifying health promotion on health facility-based childbirth, increasing collaboration among CTC maternal health workers e.g. midwives, health extension workers and TBAs, and enhancing responsiveness to traditional practices may overcome cultural barriers to institutional childbirth in Indonesia and Ethiopia.
AB - Cultural barriers to health facility-based childbirth are a common experience worldwide despite wide variations in context. Close-to-community (CTC) maternal health providers play an important role in bridging communities and health systems and their role in maternal health are particularly key. This study explored the views of CTC maternal health providers and other community members on the cultural barriers to health facility-based childbirth in two districts in Indonesia and six districts of Sidama Zone, southern Ethiopia. Employing a qualitative approach, we conducted 110 semi-structured interviews (SSIs) and 7 focus group discussions (FGDs) in Indonesia; 44 SSIs and 14 FGDs in Ethiopia. Participants in both contexts included mothers, husbands, male community members, traditional birth attendants (TBAs), village heads, local administrators, district health officials, maternal health-care workers and CTC maternal health providers. Despite significant geographical and cultural differences, the main findings were similar in the two countries’ study areas. These included: strong cultural-religious beliefs; culture of shyness and privacy around pregnancy; highly gendered decision-making related to pregnancy and childbirth; and preference for the TBA care. TBAs’ close proximity at the time of childbirth and their adherence to traditional practices were important factors influencing preference for TBAs. These cultural barriers interplay with geographical, transportation and financial factors hindering pregnant women from giving birth at a health facility. Intensifying health promotion on health facility-based childbirth, increasing collaboration among CTC maternal health workers e.g. midwives, health extension workers and TBAs, and enhancing responsiveness to traditional practices may overcome cultural barriers to institutional childbirth in Indonesia and Ethiopia.
KW - close-to-community maternal health workers
KW - Cultural barriers
KW - health facility-based childbirth
KW - partnership
KW - TBAs
U2 - 10.1080/14635240.2020.1719862
DO - 10.1080/14635240.2020.1719862
M3 - Article
SN - 1463-5240
VL - 58
SP - 109
EP - 123
JO - International Journal of Health Promotion and Education
JF - International Journal of Health Promotion and Education
IS - 3
ER -
