Birth location preferences of mothers and fathers in rural Ghana: Implications for pregnancy, labor and birth outcomes.
BACKGROUND
Maternal deaths in Sub-Saharan Africa are largely preventable with health facility delivery assisted by skilled birth attendants. Examining associations of birth location preferences on pregnant women's experiences is important to understanding delays in care seeking in the event of complications. We explored the influence of birth location preference on women's pregnancy, labor and birth outcomes.


METHODS
A qualitative study conducted in rural Ghana consisted of birth narratives of mothers (n = 20) who experienced pregnancy/labor complications, and fathers (n = 18) whose partners experienced such complications in their last pregnancy. All but two women in our sample delivered in a health facility due to complications. We developed narrative summaries of each interview and iteratively coded the interviews. We then analyzed the data through coding summaries and developed analytic matrices from coded transcripts.


RESULTS
Birth delivery location preferences were split for mothers (home delivery-9; facility delivery-11), and fathers (home delivery-7; facility delivery-11). We identified two patterns of preferences and birth outcomes: 1) preference for homebirth that resulted in delayed care seeking and was likely associated with several cases of stillbirths and postpartum morbidities; 2) Preference for health facility birth that resulted in early care seeking, and possibly enabled women to avoid adverse effects of birth complications.


CONCLUSIONS
Safe pregnancy and childbirth interventions should be tailored to the birth location preferences of mothers and fathers, and should include education on the development of birth preparedness plans to access timely delivery related care. Improving access to and the quality of care at health facilities will also be crucial to facilitating use of facility-based delivery care in rural Ghana.
Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA. cofie@unc.edu.
Leslie E
LE
Cofie
Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA. cbarring@email.unc.edu.|Carolina Population Center, UNC-Chapel Hill, Chapel Hill, NC, 27599-7445, USA. cbarring@email.unc.edu.
Clare
C
Barrington
Carolina Population Center, UNC-Chapel Hill, Chapel Hill, NC, 27599-7445, USA. singhk@email.unc.edu.|Department of Maternal and Child Health, University of North Carolina, Gillings School of Global Public Health, 401 Rosenau Hall, CB #7445, Chapel Hill, NC, 27599-7445, USA. singhk@email.unc.edu.
Kavita
K
Singh
Project Fives Alive!/Institute for Healthcare Improvement, Accra, Ghana. ssodzi-tettey@ihi.org.
Sodzi
S
Sodzi-Tettey
Boston University School of Public Health, 15 Albany St, Boston, MA, 02118, USA. akaligaung@gmail.com.
Akalpa
A
Akaligaung
D000328:Adult; D036861:Delivery, Obstetric; D005220:Fathers; D005260:Female; D005869:Ghana; D006268:Health Facilities; D006700:Home Childbirth; D006801:Humans; D008297:Male; D008875:Middle Aged; D009035:Mothers; D007744:Obstetric Labor Complications; D036801:Parturition; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D036301:Qualitative Research; D012189:Retrospective Studies; D012424:Rural Population; D050497:Stillbirth; D013997:Time Factors; D055815:Young Adult