Improving skilled birth attendance: An evidence brief for Ethiopia
Keywords:
skilled birth attendance, institutional delivery, EthiopiaAbstract
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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