With a population that is about 11% of the world population, Sub-Saharan Africa has half of maternal and child deaths. Partly as strategies to meet the Millennium Development Goals (4 and 5), numerous interventions have been implemented to combat mother and infant mortality, with special attention to health services for skilled attendance at birth. Why do the majority of women in low and medium-income countries continue to give birth outside of institutional healthcare services, increasing the risk of death?
The study, published in BMC Pregnancy and Childbirth, tried to answer this question. Analyzing data collected in the Moroto and Napak districts of Uganda (where hospital births in 2010 were 19% and 10%, respectively), the authors found a number of barriers, related to four areas:socio-cultural factors, perceived needs and benefits, economic inaccessibility and physical inaccessibility, with the latter two most dominant.
This was the first qualitative study published about the barriers to hospital delivery in the Karamoja region. Despite numerous limitations, the study deserves credit for identifying the main reasons that women do not give birth in hospitals. On the basis of these factors, the authors highlight the need for strategies targeted at alleviating poverty, improving infrastructure, raising awareness about health, and most importantly forging a dialogue between healthcare institutions and traditional birth attendants. Only a comprehensive approach considering all of these factors that lead to significant results and increase access to institutional healthcare services to directly lower the high maternal mortality rate.
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