Provision of individualised obstetric risk advice to increase health facility usage by women at risk of a complicated delivery: a cohort study of women in the rural highlands of West Ethiopia.

OBJECTIVE: To determine whether the provision of individualised obstetric risk advice would increase health facility usage in women at life-threatening risk of a complicated delivery in Ethiopia, where maternal mortality has remained high and static for a decade and where, although the government has increased the number of health facilities, 90% of women deliver their babies at home. DESIGN: A prospective cohort study. SETTING: Rural Ethiopian highlands. POPULATION: A total of 294 pregnant women at 32 weeks or more of gestation. METHODS: Before being provided with individualised risk advice, women were asked about their birth plans, and in particular, their planned delivery place. Those identified as being at risk of a complicated delivery were followed up to find out whether they altered their birth plans. MAIN OUTCOME MEASURE: A change in birthplace. RESULTS: Women identified as being at high risk of a complicated delivery significantly changed their plans (P < 0.01), with 34 (89%) women delivering in hospital. Women with a medium risk did not significantly change their birth plans (P = 0.082), with 35 (36%) delivering at home. Women with a high parity were less likely to change their birth plans compared with primigravid women (odds ratio 0.53; 95% confidence interval 0.34-0.83) and high-risk women were more likely to change their plans compared with medium-risk women (odds ratio 6.2; 95% confidence interval 1.8-21.6). CONCLUSIONS: Providing simple, individualised advice about the risks of a complicated delivery leads to high-risk women delivering in hospital. Embedding this into the current antenatal care system in Ethiopia could significantly decrease maternal mortality