Factors influencing place of delivery among pregnant women in Kisarawe District

A cross section descriptive study was conducted among mothers of under fives children in Kisarawe district from June to July 2000. The aim of the study was to describe factors that influenced where pregnant women in Kisarawe district intended to deliver and where actual delivery took place. Both structured and in-depth interviews were used for generating information. A total of 335 women participated in the study. Nearly all mothers who participated in the study (99.7%) attended antenatal care during their last pregnancy implying that the attendance of antenatal care in the study area is very high. Although the majority (88%) intended to deliver in a health facility, 80% of those who had such an intention delivered at home. The main factors that influence home delivery in the study area include cultural influences regarding the decision making process in the household on pregnancy related issues, local interpretation of pregnancy complications, and the practice of pregnant women to stay at their parents' homes during their first pregnancies. Others include number of pregnancies, lack of transport, insufficient knowledge on the early signs of labour, perceived bad reputation of health workers at the health facilities, and lack of transparency on the charges for delivery services and mode of payment. Results of this study suggest a need to pay attention to the cultural context in which pregnancy and childbirth related issues are organized. TBAs (Traditional birth attendants) should be trained to assist in both monitoring and assisting deliveries. Since the majority of pregnant women attend antenatal care they should frequently be reminded to recognize early signs of labour and remember their expected date of delivery. There is need to improve interpersonal communication between health workers and pregnant women. And the community should be involved in solving the transport problems. Transparency should be emphasized particularly with respect to cost sharing in maternal health services.