BACKGROUND Pakistan reports the highest stillbirth rate in the world at 43 per thousand births with more than three-quarters occurring in rural areas. The Global Network for Women's and Children's Health maintains a Maternal and Newborn Health Registry (MNHR) in 14 study clusters of district Thatta, Sindh Pakistan. For the last 10 years, the MNHR has recorded a high stillbirths rate with a slow decline. This exploratory study was designed to understand the perspectives of women and traditional birth attendants regarding the high occurrence of stillbirth in Thatta district. METHODS We used an exploratory qualitative study design by conducting in-depth interviews (IDIs) and focus group discussions (FGDs) using semi-structured interview guide with rural women (FGDs = 4; n = 29) and traditional birth attendants (FGDs = 4; n = 14) who were permanent residents of Thatta. In addition, in-depth interviews were conducted with women who had experienced a stillbirth (IDIs = 4). This study presents perceptions and experiences of women and TBAs regarding high rate of stillbirth in Thatta district, Karachi. RESULTS Women showed reluctance to receive skilled/ standard care when in need due to apprehensions towards operative delivery, poor attitude of skilled health care providers, and poor quality of care as service delivery factors. High cost of care, far distance to facility, lack of transport and need of an escort from the family or village to visit a health facility were additional important factors for not seeking care resulting in stillbirth. The easy availability of unskilled provider in the form of traditional birth attendant is then preferred over a skilled health care provider. TBAs shared their husband or family members restrict them to visit or consult a doctor during pregnancy. According to TBAs after delivering a macerated fetus, women are given herbs to remove infection from woman's body and uterus. Further women are advised to conceive soon so that they get rid of infections. CONCLUSION Women of this rural community carry lots of apprehension against skilled medical care and as a result follow traditional practices. Conscious efforts are required to increase the awareness of women to develop positive health seeking behavior during pregnancy, delivery and the post-partum period. Alongside, provision of respectful maternity care needs to be emphasized especially at public health facilities.

中文翻译：

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在巴基斯坦信德省撒达地区探索妇女和传统接生员对死胎的看法和经验：一项定性研究。

背景技术巴基斯坦报告了世界上最高的死产率，每千胎中有43例，其中四分之三以上发生在农村地区。全球妇女和儿童健康网络在巴基斯坦信德省撒达地区的14个研究集群中维护了孕产妇和新生儿健康注册系统（MNHR）。在过去的十年中，MNHR的死胎率很高，下降速度缓慢。这项探索性研究旨在了解妇女和传统接生员对塔塔地区死产高发的看法。方法我们采用探索性定性研究设计，通过对农村妇女（FGDs = 4; n = 29）和传统接生服务员（FGDs = 4）进行深度访谈（IDI）和焦点小组讨论（FGD），使用半结构化访谈指南。 ; n = 14）是Thatta的永久居民。此外，对经历死产的妇女进行了深入访谈（IDI = 4）。这项研究介绍了卡拉奇塔塔地区妇女和TBA对死胎发生率较高的看法和经验。结果由于对手术分娩的担心，熟练的卫生保健提供者的态度较差以及作为服务提供因素的护理质量较差，妇女在需要时不愿接受熟练/标准的护理。高昂的护理费用，距离医疗机构的距离太远，交通不便以及需要家人或村庄的护送前往医疗机构是不寻求医疗服务导致死产的其他重要因素。因此，与熟练的医疗保健提供者相比，首选传统接生员形式的非熟练提供者容易获得。待定的待婚者共享其丈夫或家人限制了他们在怀孕期间去看医生或咨询医生。根据待产的胎儿浸软后的TBA，给妇女服用草药以清除妇女身体和子宫的感染。建议其他妇女尽快受孕，以摆脱感染。结论该农村社区的妇女对熟练的医疗保健抱有很大的忧虑，因此遵循传统做法。需要作出有意识的努力，以提高妇女在怀孕，分娩和产后期间养成积极寻求健康行为的意识。旁边