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A lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical needs-a qualitative study among multiparous women in Somaliland.

Authors
  • Egal, Jama Ali1
  • Essa, Amina1
  • Yusuf, Rahma1
  • Osman, Fatumo2
  • Ereg, Derie3
  • Klingberg-Allvin, Marie2
  • Erlandsson, Kerstin2
  • 1 Lead Department of Midwifery, College of Medicine & Health Sciences, University of Hargeisa, Hargeisa, Somaliland. , (Mali)
  • 2 Institution for Health and Welfare, Dalarna University, Falun, Sweden. , (Sweden)
  • 3 College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland. , (Mali)
Type
Published Article
Journal
Global Health Action
Publisher
Informa UK (Taylor & Francis)
Publication Date
Dec 31, 2022
Volume
15
Issue
1
Pages
2054110–2054110
Identifiers
DOI: 10.1080/16549716.2022.2054110
PMID: 35389334
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Around 20% of births in Somaliland take place at health facilities staffed by trained healthcare professionals; 80% take place at home assisted by Traditional Birth Attendants (TBAs) with no formal training. There has been no research into women's choice of place of birth. In this study, we explore multipara women's needs and preferences when choosing the place of birth. An explorative qualitative study using individual in-depth interviews analysed inductively using content analysis. The interviews were conducted in Somaliland with 25 multiparous women who had experience of giving birth both at home and at a health facility within the past three years. The results provide a description of how, for women in Somaliland, a lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical need. The women in this study desired intentionality in their role as mothers and sought some measure of control over the environment where they planned to give birth, depending on the circumstances of that particular birth. The results describe what quality care means for multipara women in Somaliland and how women choose birthplace based on previous experiences of care. The expectation of respectful care was a vital part for women when choosing a place of birth. To meet women's needs and preferences in Somaliland, further investments are needed to strengthen the midwifery profession and to define and test a context specific midwife-led continuity of care model to be scaled up. A dialogue to create new roles and responsibilities for the TBAs who attend most home births is further needed to link them to the formal healthcare system and assure timely healthcare seeking during pregnancy and birth.

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