Improving skilled birth attendance: An evidence brief for Ethiopia

Authors

  • Mamuye Hadis Ethiopian Public Health Institute Author
  • Amanuel Dibaba Ethiopian Public Health Institute Author
  • Sabit Ababor Ethiopian Public Health Institute Author
  • Yibeltal Assefa Ethiopian Public Health Institute Author

Keywords:

skilled birth attendance, institutional delivery, Ethiopia

Abstract

Background: Skilled birth attendance in Ethiopia is the lowest in the world (WHO 2007). Little attention has been given to demand-side barriers of healthcare (socio-cultural, geographical and financial) by policy makers or researchers, even though such barriers are particularly important to poor communities.  Finding ways to overcome demand-side barriers could help address this problem.

Objective: The objective of this policy brief was to summarize the best available evidence describing the problem and potential solutions for addressing the problem of low level of skilled birth attendance in Ethiopia.

Methods: This policy brief brings together global research evidence (from systematic reviews) and local evidence to inform deliberations about improving skilled birth attendance in Ethiopia. We searched for relevant evidence describing the problem, the impacts of options for addressing the problem, barriers to implementing those options, and implementation strategies to address these barriers.

Results: Policy options include the following:(i) Community mobilization probably increases the proportion of institutional deliveries (ii) Cultural adaptation of birthing places might address one of the reasons why some women do not go to a birth facility, particularly in rural populations. The effects of cultural adaptations of birthing services on increasing skilled birth attendance are uncertain hence need further investigation.  (iii) Maternity waiting homes might address the problem of long distances between where people live and birthing facilities for rural populations with limited access to emergency obstetric care. The effects of maternity waiting homes are uncertain hence need further investigation. (iv) Conditional cash transfer programs may increase institutional deliveries. The costs and cost effectiveness of all four options are uncertain. Rigorous evaluation and monitoring of resource use is, therefore, warranted.

Implementation strategies include production of clear guidelines (manuals) for all options, quality improvement programs, establishment of a culturally competent primary healthcare system by developing relevant cultural competence guidelines and mobilization of financial resources.

Conclusions: Socio-cultural, distance and financial barriers are among the major causes for the low level of skilled birth attendance in Ethiopia. A clear strategy addressing these barriers is crucial to improve skilled birth attendance in Ethiopia.

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Author Biographies

  • Mamuye Hadis, Ethiopian Public Health Institute

    Ethiopian Public Health Institute, P O Box 1242, Addis Ababa, Ethiopia.

  • Amanuel Dibaba, Ethiopian Public Health Institute

    Ethiopian Public Health Institute, P O Box 1242, Addis Ababa, Ethiopia.

  • Sabit Ababor , Ethiopian Public Health Institute

    Ethiopian Public Health Institute, P O Box 1242, Addis Ababa, Ethiopia.

  • Yibeltal Assefa, Ethiopian Public Health Institute

    Ethiopian Public Health Institute, P O Box 1242, Addis Ababa, Ethiopia.

References

ACCESS (2010). Community Mobilization: An effective strategy to improve MNH. Access end of project, October 1, 2004-March 21, 2010.

Anderson, LM., Susan, CS., Mindy, TF., Jonathan, EF. & Jacques, N. (2003). Culturally competent healthcare systems: A systematic review. American Journal of Preventive Medicine, 24 (Suppl.), 68–79.

Anon, List of countries of the World - Density of road network. url:http://en.worldstat.info

Bedford, J., Gandhi, M., Admassu, M. & Girma, A. (2013). A normal delivery takes place at home: A qualitative study of the location of childbirth in rural Ethiopia. Maternal and Child Health Journal, 17, 230–239.

Central Statistical Agency & ICF International, 2012. Ethiopia Demographic and Health Survey 2011. (March), p. 450.

Doetinchem, OXK. & Carrin, G. (2008). Conditional cash transfers: what’s in it for health? Technical Briefs for Policy-Makers, (1), p. 7. url: http://www.Who.int/healthfinancing/document/cov-pb e_08_1- cct.

Dudley, LD. (2011). Do maternity waiting homes improve maternal and neonatal outcomes in low- resource settings? A SUPPORT Summary of a systematic review. May 2011. www.support- collaboration. org /summaries.htm, (May), pp.1–5.

FMoH (2006). National Reproductive Health Strategy 2006 - 2015. Federal Democratic Republic of Ethiopia Ministry of Health, (March), pp.1–46.

FMoH (2010). Implementation manual for health care financing. Addis Ababa.

FMoH. (2013). Annual performance report, 2005 EFY., p.144.

Fretheim, A., Babigumira, S., Oxman, AD., Lavis, JN. & Lewin S. (2010). Support tools for evidence-informed policymaking in health 6: Using research evidence to address how an option will be implemented. Chinese Journal of Evidence-Based Medicine, 10(3), pp. 276–283.

Government of Ethiopia. (2008). Summary and statistical report of the 2007 population and housing census-population size by age and sex. Addis Ababa, December, p.113. url: http://scholar. Google. com.

Gabrysch, S. & Campbell, OMR. (2009). Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy and Childbirth, 9, 34.

Graham, WJ., Bell, JS. & Bullough, CH. (2001). Can skilled attendance at delivery reduce maternal mortality in developing countries? Studies in health services, organization and policy, 17, pp. 97–130.

Handa, S. & Davis, B. (2006). CCT - The experience of conditional cash transfers in Latin America and the Caribbean. Development Policy Review, 24, 513–536.

Hounton, S., Byass, P. & Brahima, B. (2009). Towards reduction of maternal and perinatal mortality in rural Burkina Faso: Communities are not empty vessels. Global health action, 2. url at: http://www.globalhealthaction.net/index. IRIN. (2012). ETHIOPIA: Still too many deaths in childbirth. Addis Ababa: IRIN News.

Koblinsky, M., Tain, F. & Tesfaye, S. (2010). Reducing maternal mortality and increasing use of skilled birth attendance: Ethiopia and MDG 5. Ethiopian Journal of Reproductive Health, 4, 4-15.

Kruk, ME., Paczkowski, MM., Tegegn, A., Tessema, F., Hadley, C., Asefa, M. et al. (2010). Women’s preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery. Journal of Epidemiology and Community Health, 64, 984–988.

Lagarde, M., Haines, A. & Palmer, N. (2007). Conditional cash transfers for improving uptake of health. Journal of the American Medical Association, 298, 1900–1910.

Lavis, JN., Wilson, MG., Oxman, AD., Lewin, S. & Fretheim, A. (2009). Support tools for evidence-informed health policymaking (STP) 4: Using research evidence to clarify a problem. Health Research Policy Systems, 7 (Suppl 1), S1-S4.

Lavis, JN., Wilson, MG., Oxman, AD., Grimshaw, J., Lewin, S. & Fretheim, A. (2009). Support tools for evidence-informed health policymaking (STP) 5: Using research evidence to frame options to address a problem. Health Research Policy Systems, 7 (Suppl 1), S5.

Lawn, JE., Anne, CC., Lee, MK., Lynn, S., Wally, AC., Vinod, P. . (2009). Two million intrapartum -related stillbirths and neonatal deaths: Where, why, and what can be done? International Journal of Gynecology and Obstetrics, 107 (Suppl.), S5–S19.

Lee, ACC., Lee, JE., Lawn, SC., Vishwajeet, K., David, O., Zulfiqar, A. et al. (2009). Linking families and facilities for care at birth: What works to avert intrapartum-related deaths? International Journal of Gynecology and Obstetrics, 107 (Suppl.1), S65-S89.

Marshal, S. (2005). A Cultural competence guide for primary health care professionals in Nova Scotia., p. 50.

Medhanyie, A., Mark, S., Yohannes, K., Nikki, S., David, S., Roman, B. et al. (2012). The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study. BMC Health Services Research, 12, 352.

Pantoja, T. (2008). Do conditional cash transfers improve the uptake of health interventions in low and middle income countries? A support Summary of a Systematic Review, (August), pp.1–5. url: http://scholar.google.com/scholar?

Pearson, L., Gandhi, M., Admasu, K. & Keyes, EB. (2011). User fees and maternity services in Ethiopia. International Journal of Gynecology and Obstetrics, 115, 310–315.

Rosato, M., Glenn, L., Lisa, HG., Prasanta, T., Nirmala, N., Charles M., et al. (2008). Community participation: lessons for maternal, newborn, and child health. Lancet, 372 (9642), 962–971.

Sabine, G., Claudia, L., Eduardo, B., Marco, AB., Rosa., M., Oona, MRC. et al. (2009). Cultural adaptation of birthing services in rural Ayacucho, Peru. Bulletin of the World Health Organization, 87, 724–729.

Schubert, B. & Slater, R. (2006). Social cash transfers in low-income African countries: Conditional or unconditional? Development policy review, 24,571–578.

Stanton, C. (2008). Steps towards achieving skilled attendance at birth. Bulletin of the World Health Organization, 86, 242-243.

Steinmann, P. (2010). Can community mobilization reduce intrapartum-related deaths? SUPPORT Summary of a systematic review. url: www.support-collaboration.org/summaries.htm.

UNDP (2011). Human Development Report 2011. Sustainability and equity: a better future for all, New York.

Van Lonkhuijzen, L., Stekelenburg, J. & Van Roosmalen, J. (2009). Maternity waiting facilities for improving maternal and neonatal outcome in low-resource countries (Review). Cochrane Database of Systematic Reviews, 3 (CD006750).

WHO (2007). Factsheet Proportion of births attended by a skilled attendant – 2007 updates Factsheet. p.8.

WHO (1996). Maternity Waiting Homes: A review of experiences. Geneva: WHO, 96 (21), pp.1–44.

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Published

2023-11-16

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Section

Original Article

How to Cite

Hadis, M. (2023) “Improving skilled birth attendance: An evidence brief for Ethiopia”, Ethiopian Journal of Public Health and Nutrition (EJPHN), 1(1), pp. 32–40. Available at: https://ejphn.ephi.gov.et/index.php/ejphn/article/view/25 (Accessed: 18 June 2024).

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