Background: Maternal mortality is a common event for women in the poorer parts
of the world. The maternal mortality ratio in Ethiopia is 412 per 100,000 live births.
Most high burden countries including Ethiopia have strategies to provide skilled
maternity care yet very few are making progress, due at least in part to not ensuring
quality facility childbirth care. In Ethiopia, there are no studies on woreda (district)
level factors associated with skilled birth attendance (SBA) rates, and evidence on
quality of Labour and Delivery (L&D) care is generally scarce. Therefore, this
project aimed at closing this gap.
Methods: Two quantitative studies were conducted. The first study described
variation in woreda SBA rates (N=839) and determinants of higher rates using a
cross-sectional ecologic study design. The second study examined quality of
birthing care in government hospitals (n=20) of Southern Nations and Nationalities
Region (SNNPR) by collecting primary data, using a cross-sectional study design.
Key findings: The first study showed that the mean woreda-level SBA rate in
Ethiopia was low at an ecologic level, but with substantial variations. Women’s
families, the wider community, availability of health resources, and proportion of
four or more antenatal care significantly increased the SBA rate.
The second study revealed gaps in the structural, process and outcome aspects
of quality of L&D care in the hospitals. About two thirds of the required inputs were
fulfilled, and only two hospitals fulfilled almost all the standards. Laboratory
services and safe blood, essential drugs, supplies and equipment were the areas
with the largest gaps. In terms of process quality, about two thirds of the standards
were met overall for each woman for which she was eligible. The highest scores
were achieved with immediate and essential newborn care practices, and care
during the second and third stages of labour. History of a danger sign in the current
pregnancy had a positive effect on the process quality at the level of each woman.
At hospital level, teaching status and structural quality index score had significant
positive effects, whilst annual L&D service volume had a significant negative effect
on the process quality index score. Perceived quality of L&D care provided was
also suboptimal. Being illiterate, absence of a complication after birth, perceived
high quality of interpersonal communication and emotional support,
responsiveness, health education and physical environment; all positively
influenced women’s overall experience. Furthermore, teaching status and primary
or general level of hospitals, staff training, and high quality of L&D care process
index also positively affected the experience.
Recommendations: It is essential to increase the coverage of four or more ANC
visits and strengthen the current community-based approaches to meaningfully
increase the SBA rate. There is a need to ensure that all hospitals meet the
required structure to enable the provision of quality routine L&D care, with
particular emphasis on laboratory services and safe blood for emergency
transfusion, and availability of essential drugs, supplies and equipment. It is also
important to focus efforts on the factors that showed a significant effect on the
process quality of routine L&D care process and the women’s experience with the
care received
