Reasons for low level of skilled birth attendance in Afar pastoralist community, North East Ethiopia: a qualitative exploration.
Introduction
Ethiopia has expanded the number of health facilities that offer maternal health services during the last two decades. However, the utilization of skilled birth attendants in health facilities is still very low especially among the pastoralist regions of the country. This study explored why women in the pastoralist region of Afar, Ethiopia still prefer to give birth at home.


Methods
A qualitative study approach was used to collect information from October to December 2015. A total of eighteen focus group discussions and twenty-four key informant interviews were conducted. Focus group discussions were separately conducted with mothers and male tribal or religious leaders. Key informant interviews were conducted with heads of Women's Affairs Bureau, district health office heads and traditional birth attendants. Data were coded and categorized using open code software for qualitative data management and analyzed based on a thematic approach.


Results
Women preferred to deliver at home due to lack of awareness about the benefits of maternity health facilities, their nomadic lifestyle, lack of confidence and trust in health workers and their close affinity and easy access to traditional birth attendants. Supply-side barriers included distant health facilities, lack of transportation and poor health care.


Conclusion
Demand and supply related factors were identified as barriers to utilization of skilled birth attendants. Increasing awareness, bringing the service closer, arranging maternity waiting area around health facilities, and creating client-friendly service were found critical. Future research to define and improve services and approaches suitable for pastoralist population is warranted.
['Ibrhim|Mohammed Ahmed|MA|', 'Demissie|Meaza|M|', 'Medhanyie|Araya Abrha|AA|', 'Worku|Alemayehu|A|', 'Berhane|Yemane|Y|']
D000328:Adult D000368:Aged D005002:Ethiopia D005260:Female D017144:Focus Groups D006297:Health Services Accessibility D006700:Home Childbirth D006801:Humans D008297:Male D008427:Maternal Health Services D008875:Middle Aged D008880:Midwifery D011247:Pregnancy D055815:Young Adult
Pastoralist Ethiopia Afa health facility delivery home delivery