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. 2016 Dec 15;11(12):e0168083.
doi: 10.1371/journal.pone.0168083. eCollection 2016.

Barriers to Institutional Childbirth in Rumbek North County, South Sudan: A Qualitative Study

Calistus Wilunda  1 , Chiara Scanagatta  2 , Giovanni Putoto  2 , Risa Takahashi  3 , Francesca Montalbetti  4 , Giulia Segafredo  2 , Ana Pilar Betrán  5
Affiliations

Barriers to Institutional Childbirth in Rumbek North County, South Sudan: A Qualitative Study

Calistus Wilunda et al. PLoS One. .

Abstract

Background: South Sudan has one of the world's poorest health indicators due to a fragile health system and a combination of socio-cultural, economic and political factors. This study was conducted to identify barriers to utilisation of institutional childbirth services in Rumbek North County.

Methods: Data were collected through 14 focus group discussions with 169 women and 45 men, and 18 key informant interviews with community leaders, staff working in health facilities, traditional birth attendants, and the staff of the County Health Department. Data were analysed using inductive content analysis.

Results: The barriers to institutional childbirth were categorised under four main themes: 1) Issues related to access and lack of resources: long distance to health facilities, lack of transportation means, referral problems, flooding and poor roads, and payments in health facilities; 2) Issues related to the socio-cultural context and conflict: insecurity, influence of the husband, lack of birth preparedness, domestic chores of women, influence of culture; 3) Perceptions about pregnancy and childbirth: perceived benefit of institutional childbirth, low childbirth risk perception, and medicalisation of childbirth including birth being perceived to be natural, undesirable birth practices, privacy concerns, and fear of caesarean section; and 4) Perceptions about the quality of care: inadequate health facility infrastructure and perceived neglect during admission.

Conclusions: Multiple factors hinder institutional childbirth in Rumbek North. Some of the factors such as insecurity and poor roads are outside the scope of the health sector and will require a multi-sectoral approach if childbirth services are to be made accessible to women. Detailed recommendations to increase utilisation of childbirth services in the county have been suggested.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Participants’ flow chart.
CHD: County Health Department; PHCC: Primary Health Care Centre; PHCU: Primary Health Care Unit; TBA: Traditional birth attendant.
See this image and copyright information in PMC

References

    1. United Nations. Sustainable Development Goals 2015 [20.05.2016]. https://sustainabledevelopment.un.org/?menu=1300.
    1. United Nations. The Millennium Development Goals Report 2015. New York: United Nations; 2015.
    1. WHO, UNICEF, UNFPA, World Bank Group, UNPD. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015.
    1. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2014;384(9947):980–1004. - PMC - PubMed
    1. Ministry of Health, National Bureau of Statistics. The Republic of South Sudan: The Sudan Household Health Survey 2010. Juba: National Bureau of Statistics; 2010.