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Cultural norms create a preference for traditional birth attendants and hinder health facility-based childbirth in Indonesia and Ethiopia: a qualitative inter-country study
International Journal of Health Promotion and Education Pub Date : 2020-02-03 , DOI: 10.1080/14635240.2020.1719862
Sudirman Nasir 1 , Aschenaki Zerihun Kea 2 , Rosalind Steege 3 , Ralalicia Limato 4 , Patricia Tumbelaka 4 , Daniel Gemechu Datiko 2 , Syafruddin 4 , Maryse Kok 5 , Rukhsana Ahmed 6 , Miriam Taegtmeyer 7
Affiliation  

ABSTRACT Cultural barriers to health facility-based childbirth are a common experience worldwide despite wide variations in context. Close-to-community (CTC) maternal health providers play an important role in bridging communities and health systems and their role in maternal health are particularly key. This study explored the views of CTC maternal health providers and other community members on the cultural barriers to health facility-based childbirth in two districts in Indonesia and six districts of Sidama Zone, southern Ethiopia. Employing a qualitative approach, we conducted 110 semi-structured interviews (SSIs) and 7 focus group discussions (FGDs) in Indonesia; 44 SSIs and 14 FGDs in Ethiopia. Participants in both contexts included mothers, husbands, male community members, traditional birth attendants (TBAs), village heads, local administrators, district health officials, maternal health-care workers and CTC maternal health providers. Despite significant geographical and cultural differences, the main findings were similar in the two countries’ study areas. These included: strong cultural-religious beliefs; culture of shyness and privacy around pregnancy; highly gendered decision-making related to pregnancy and childbirth; and preference for the TBA care. TBAs’ close proximity at the time of childbirth and their adherence to traditional practices were important factors influencing preference for TBAs. These cultural barriers interplay with geographical, transportation and financial factors hindering pregnant women from giving birth at a health facility. Intensifying health promotion on health facility-based childbirth, increasing collaboration among CTC maternal health workers e.g. midwives, health extension workers and TBAs, and enhancing responsiveness to traditional practices may overcome cultural barriers to institutional childbirth in Indonesia and Ethiopia.

中文翻译:

印度尼西亚和埃塞俄比亚的文化规范偏爱传统助产士并阻碍基于医疗机构的分娩:一项定性的跨国研究

摘要 尽管环境差异很大,但在医疗机构分娩的文化障碍在世界范围内普遍存在。贴近社区 (CTC) 的孕产妇保健提供者在连接社区和卫生系统方面发挥着重要作用,他们在孕产妇保健中的作用尤为关键。本研究探讨了 CTC 孕产妇保健提供者和其他社区成员对印度尼西亚两个地区和埃塞俄比亚南部 Sidama 地区六个地区基于医疗机构分娩的文化障碍的看法。我们采用定性方法,在印度尼西亚进行了 110 次半结构化访谈 (SSI) 和 7 次焦点小组讨论 (FGD);埃塞俄比亚有 44 个 SSI 和 14 个 FGD。这两种情况的参与者包括母亲、丈夫、男性社区成员、传统助产士 (TBA)、村长、地方行政人员、地区卫生官员、孕产妇保健工作者和 CTC 孕产妇保健提供者。尽管存在显着的地理和文化差异,但两国研究领域的主要发现相似。其中包括: 强烈的文化宗教信仰;怀孕期间的害羞和隐私文化;与怀孕和分娩有关的高度性别化的决策;和偏好 TBA 护理。TBA 在分娩时的近距离接触以及他们对传统习俗的遵守是影响 TBA 偏好的重要因素。这些文化障碍与阻碍孕妇在医疗机构分娩的地理、交通和经济因素相互作用。加强在医疗机构分娩的健康促进,
更新日期:2020-02-03
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