Women’s Social Networks, Use of Skilled Birth Attendants, and Experience of Quality in Delivery Services in Jabi Tehinan Woreda of The Amhara Region, North West Ethiopia
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Date
2014-07
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Addis Ababa University
Abstract
High maternal mortality has remained an unmet public health challenge, particularly in
the developing world. Though maternal mortality ratio estimates for Ethiopia vary
considerably due to methodological differences, most agree that maternal mortality is
among the highest in the world. Since most maternal deaths occur during labor, delivery,
and the immediate postpartum period, skilled birth attendants (SBAs) at every delivery
have been recommended to bring a marked reduction in maternal mortality. Nonetheless,
the majority of women in Ethiopia give birth at home assisted by untrained traditional
birth attendants, relatives, or neighbors. This study investigated women’s social
networks, use of SBA, and the quality of facility delivery services experienced by women
in Jabi Tehinan Woreda of Amhara Region, North West Ethiopia. The study employed
mixed methods research design. Quantitative data were collected retrospectively from
134 women who had uncomplicated births at health facilities and 140 women who had
uncomplicated births at home within a year preceding the survey. Eight women who had
uncomplicated births at a health facility and 11 women who had uncomplicated births at
home also participated in the qualitative study. Univariate and multivariate logistic
regression were used to analyze quantitative data. The qualitative data were transcribed
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and themes were developed for analyses. The results indicated that social network
variables were significantly associated with SBAs use for delivery. Social networks better
explain use of a facility for delivery services than women’s individual attributes. Women
embedded within homogeneous network members were 2.493(95% CI: 1.251-4.969)
times more likely to deliver at health facilities than women embedded within less
homogeneous network members and the odds of women delivering at a health facility
increased with increasing network size. Women embedded within high SBA endorsement
network member were 7.849 (95% CI: 3.906-15.773) times more likely to deliver at
health facilities than women embedded within low SBA endorsement network members.
Social networks facilitate SBA utilization by serving as a reference for the behavior and
sharing information about the available facility delivery services and the quality of the
services. The odds of urban women to deliver in a health facility is 3.246 (95% CI: 1.362-
7.734) times higher than rural women. The odds of women who had better knowledge of
obstetric complications to deliver in a health facility is 3.224 (95% CI: 1.564-6.647)
times higher than women who had limited knowledge about the complications. Nearly
half of the women (48%) who delivered at a health facility evaluated the quality of
delivery services as poor. Informants shared that attendants are not sympathetic for
women’s pains and feelings and there is lack of privacy associated with the birthing
position at health facilities. These findings inform health professionals and other
stakeholders to understand the roles of women’s social networks and the quality of
facility delivery services in designing interventions to increase the proportion of women
who deliver at health facilities. The findings are also important for social work education
and designing social work interventions with pregnant women and their families
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Social Work