The influence of husbands' approval on women's use of prenatal care: Results from Yirgalem and Jimma towns, south west Ethiopia

Background: The utilization of formal prenatal care services in Ethiopia could generally be described as low by international standards. While this is attributed to the lack of access to formal maternal health-care service, which is an important barrier to prenatal care, other important socio-cultural barriers to service utilization also exist. Objective: The aim of this study is to identify the relative influence of the attitudes and background characteristics of husbands and wives on prenatal care utilization, and in particular to identify the role of a husband's approval on prenatal care. Methods: Data were collected from 1,750 women in a community-based survey of maternal health conducted in Yirgalem town and its surrounding rural areas, as well as in Jimma Town in 1997. Multivariate regression models were used to identify: (1) the relationship between the determinants of whether a woman wanted a pregnancy and whether a husband approves of prenatal care, and (2) the influence of a husband's approval on care utilization net of pregnancy wantedness and other factors. Results: It was found out that a husband's approval has a greater effect on prenatal care utilization than whether a wife wanted the pregnancy or a wife's level of education. It was also found that the impact of a husband's approval on prenatal care is greatest among women under the age of 20. Conclusion: The findings of this study underscore the importance of targeting men when designing interventions that are intended to raise the awareness and use of prenatal health-care services. The Ethiopian Journal of Health Development Vol. 20 (2) 2006: 84-9

Why Give Birth in Health Facility? Users' and Providers' Accounts of Poor Quality of Birth Care in Tanzania.

In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members. Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region. Health care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation. There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study indicate that there is a long way to go