title: Birth preparedness and complication readiness - a qualitative study among community members in rural Tanzania.
abstract: BACKGROUND
  Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR.
  
  
  METHODS
  A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data.
  
  
  RESULTS
  The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees.
  
  
  CONCLUSIONS
  This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.
authors.affiliation: Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.|Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden; drfuraha@gmail.com.
authors.forename: Furaha
authors.initials: F
authors.lastname: August
authors.affiliation: Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.|Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Pembe
authors.affiliation: Institute of Traditional Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Edmund
authors.initials: E
authors.lastname: Kayombo
authors.affiliation: Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Columba
authors.initials: C
authors.lastname: Mbekenga
authors.affiliation: Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Axemo
authors.affiliation: Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.|Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Darj
mesh_terms: D000328:Adult; D000368:Aged; D005190:Family / Q000523:psychology; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000458:organization & administration; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000191:economics / Q000458:organization & administration*; D008875:Middle Aged; D036801:Parturition / Q000523:psychology*; D011295:Prenatal Care / Q000458:organization & administration; D036301:Qualitative Research; D012424:Rural Population; D013636:Tanzania
keywords: birth preparedness and complication readiness; perceptions; rural Tanzania