The uptake of skilled birth attendants’ services in rural Nepal: A qualitative study

Aim and objective: The general aim of this research was to explore why women do or do not want to uptake Skilled Birth Attendants’ (SBAs) services during childbirth. The objective was to explore the factors affecting the uptake of SBAs’ services during childbirth in rural Nepal. Methods: Semi-structured interviews were conducted. The data were analysed using thematic analysis. Setting: The fieldwork was conducted in a rural area, in a western hill district of Nepal. Participants: Interviews were conducted with 24 married women aged 18-49, who had given birth during the three years prior to the time of interview. Sixteen women were SBA users and eight were non-SBA users. Eight relatives, such as husbands, and parents-in-law were also interviewed as key informants. Findings: Four themes were identified as affecting the uptake of skilled care during childbirth: (1) Women’s individual characteristics; (2) Choice of, and access to, SBA services; (3) Cultural practice, gender role and decision making; and (4) Attitude and quality of SBAs and the hospital environment. Conclusion: A wide range of factors affect the uptake of SBAs services. These include: lack of SBAs in rural areas; women’s autonomy; difficult terrain; widespread poverty and illiteracy; limited resources and traditional and cultural attitudes; and gender factors. However, to date, women’s experiences and preferences have been overlooked in service design and development. There is a need for specific maternity service development, based on women’s experiences and perceptions. The establishment of a fully trained cadre of midwives, operating according to a professional code of ethics, could improve the quality of care in the existing health care facilities