We found evidence in the studies that despite being able to recognise danger signs during pregnancy sometimes women remain silent and do not seek care because of cultural beliefs about the underlying causes. For example, in Tanzania obstructed labour, retained placenta and eclampsia were associated with adultery. In some countries BPCR actions are limited due to fear of unfavourable outcomes and the belief that ‘preparing’ could bring bad luck. In Tanzania and Kenya, although families reportedly discussed pregnancy and childbirth together (including husbands and wives), the studies indicate that taboos still exist and that this can restrict BPCR discussions. For example, announcing pregnancy and informing the husband when labour starts, is believed to bring misfortune, limiting husbands’ ability to make timely preparations. Cultural beliefs and norms also hindered transport preparations in some contexts, as women refrained from crossing a river since this was believed to cause abortion/preterm birth, and travel at night was considered dangerous due to active evil spirits. In Bangladesh and Kenya, purchasing relevant items in preparation for birth was reportedly discouraged, especially items for the baby. Financial preparations were perceived as wasteful as it is unknown if the child would survive.
Factors influencing implementation of interventions to promote birth preparedness and complication readiness
Factors influencing implementation of interventions to promote birth preparedness and complication readiness. Andrea Solnes Miltenburg, Yadira Roggeveen, Jos van Roosmalen and Helen Smith. BMC Pregnancy and Childbirth 2017;17:270 https://doi.org/10.1186/s12884-017-1448-8
Abstract / Summary:
Background: The recent WHO report on health promotion interventions for maternal and newborn health recommends birth preparedness and complications readiness interventions to increase the use of skilled care at birth and to increase timely use of facility care for obstetric and newborn complications. However, these interventions are complex and relate strongly to the context in which they are implemented. In this article we explore factors to consider when implementing these interventions. Methods: This paper reports a secondary analysis of 64 studies on birth preparedness and complication readiness interventions identified through a systematic review and updated searches. Analysis was performed using the Supporting the Use of Research Evidence (SURE) framework to guide thematic analysis of barriers and facilitators for implementation. Results: Differences in definitions, indicators and evaluation strategies of birth preparedness and complication readiness interventions complicate the analysis. Although most studies focus on women as the main target group, multi-stakeholder participation with interventions occurring simultaneously at both community and facility level facilitated the impact on seeking skilled care at birth. Increase in formal education for women most likely contributed positively to results. Women and their families adhering to traditional beliefs, (human) resource scarcities, financial constraints of women and families and mismatches between offered and desired maternity care services were identified as key barriers for implementation. Conclusions: Implementation of birth preparedness and complication readiness to improve the use of skilled care at birth can be facilitated by contextualizing interventions through multi-stakeholder involvement, targeting interventions at multiple levels of the health system and ensuring interventions and program messages are consistent with local knowledge and practices and the capabilities of the health system.
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