Perceived community acceptance on traditional birth attendants assisted childbirth care and associated factors among pregnant women in Ethiopia

Abstract

Background: Community acceptance of Traditional birth attendants (TBAs) as professional birth attendant was reported as one of the bottlenecks that has been hindering facility childbirth care service use. Hence, the World Health Organization (WHO) recommended that all childbirths needed to be attended by professional skilled attendants who at least possessed midwifery skill through the safe motherhood initiative. However, many births in developing countries have been being attended by Traditional birth attendants (TBAs) mainly due to pregnant women and community acceptance for TBAs as sole birth attendants. Therefore, measuring pregnant women's perceived community acceptance towards TBAs assisted childbirth care and identifying factors could be imperative. This provides evidence for policy makers, health program managers and health care practitioners in their effort to escalate skilled and facility childbirth care there by improving maternal and newborn health outcome.

Methods: This study had used the cross-sectional baseline data from Performance and monitoring for action Ethiopia (PMA_Et) cohort one survey which enrolled and collected data from currently pregnant women and recently postpartum women. The baseline survey collected real time data on various sexual, reproductive, maternal and new born nationwide priority indicators using customized Open Data Kit Mobile application. These data were collected using standard pretested questionnaire prepared in three local languages (Amharic, Afan Oromo and Tigrigna) by well experienced resident enumerators. The final sample size was 2,186 women who were pregnant by the time of the survey and who provided response for the perceived community acceptance for TBAs assisted childbirth care question item. Frequencies were computed to describe the study participant's characteristics. Multinomial logistics regression statistical model building process was employed to identify associated factors of perceived community acceptance for childbirths to be attended by TBAs. 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: The overall proportion of perceived community acceptance for TBAs assisted childbirth care was found to be 58.63% (95%CI: 56.47%, 60.76%). Attending primary education was found to increase the likelihood of pregnant women perceived community acceptance by most people in their community for TBAs assisted childbirth care. Women having intentions to have another child were found to have higher likelihood perceived community acceptance by few people in their community for TBAs assisted childbirth care. On the contrary, religion, residing in the well to do households, residing in the Southern nations, nationalities and Peoples Region (SNNPR) and Addis Ababa had lowered pregnant women's perceived community acceptance by most, few and some pleople in their community for TBAs assisted childbirth care.

Conclusions: The overall substantially greater proportion of pregnant perceived community acceptance for TBAs assisted childbirth care calls up on tremendous work to be done to avert such high level pregnant women perceived community acceptance for childbirths to be assisted by TBAs. Activities targeting in improving women economic status and empowerment; increasing women enrollment to secondary and higher education; using religious leaders and institutions to promote skilled delivery and childbirth care service use could likely aid in mitigating such huge surge of misconceptions towards childbirth care attendants. This significant perceived community acceptance substantially impact maternal and newborn health outcomes negatively which calls for awareness creation through community campaign to reverse this skewed perception. The activities and interventions need to be region specific. The finding also underscores the relevance of birth preparedness and complication readiness. The implication of the study is that the Health Minister and relevant actors need to design and implement region specific programs and strategies on women reproductive health empowerment and skilled childbirth care service use improvement. The other key implication of the finding was serving as one source of evidence to follow the WHO's recommendation aimed at reducing maternal mortality through skilled delivery and childbirth care service provision. It also served to track the status of the new role of TBAs to serve as a liaison between the pregnant women and the modern health care system to escalate skilled childbirth care services.

Keywords: Deliveries, TBAs assisted Childbirth care; Delivery care by TBAs, PMA; Ethiopia; Traditional birth attendants; Women Health.

Fig. 1

Proportion of Perceived Community Acceptance for TBAs Assisted Childbirth care with 95% CI among Pregnant Women PMA Cohort One Nov 2019 to Jan 20; evidence from PMA Cohort One Baseline cross-sectional data set: Nov 2019 to Jan 20