The Reasons Why Women Choose Homebirth with Traditional Birth Attendants and the Effectiveness of Interventions to Promote Institutional Delivery in Rural Gamo Zone, Ethiopia, 2017-2022

In Ethiopia, the rural community are scattered over a wide geographic area some with difficult mountains and valleys. Hence, geographic barriers and limited information sources are likely to influence women’s access to skilled birth attendance. As part of improving access and overcoming physical or geographical inaccessibility in rural areas, maternity waiting homes (MWH); residential lodgings built near healthcare facilities where expectant women near or at term would stay till the onset of labour is one of the measures taken by the Ethiopian government. The majority of the rural populations commonly have a lower perception of health services in general, and many traditional practices support behaviours that are inconsistent with effective health interventions. Thus, there is still a challenge with respect to behaviour (social norms, beliefs and culture) from the demand side related to utilizing the maternity services on top of non/partial functionality of the existing maternity waiting homes. Therefore, this research project aimed at determining the effectiveness of community-based continuous training along with upgrading the existing MWHs on maternal services uptake among expectant women in rural Gamo zone, southern Ethiopia. This PhD involves a series of four studies. The findings from the first three studies were used to inform the development of an intervention to be tested in Study 4. The first study will be an explorative qualitative study to identify the reasons for choosing home birth with the assistance of TBAs. The second study will focus on pooling evidence on maternal health and maternity waiting homes in sub-Saharan Africa, a systematic review and meta-analysis. The third will be a community-based cross-sectional study with the aim to identify maternity waiting homes utilization and its barriers in Gamo zone, Southern Ethiopia using a mixed-methods design. The last study will be a prospective quasi-experimental controlled study to evaluate the effectiveness of promoting and upgrading the existing maternity waiting homes to improve skilled attendance at birth in southern Ethiopia.