title: Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs) in Rural Bangladesh: A Qualitative Exploration.
abstract: OBJECTIVE
  Although Bangladesh has made significant progress in reducing maternal and child mortality in the last decade, childbirth assisted by skilled attendants has not increased as much as expected. An objective of the Bangladesh National Strategy for Maternal Health 2014-2024 is to reduce maternal mortality to 50/100,000 live births. It also aims to increase deliveries with skilled birth attendants to more than 80% which remains a great challenge, especially in rural areas. This study explores the underlying factors for the major reliance on home delivery with Traditional Birth Attendants (TBA) in rural areas of Bangladesh.
  
  
  METHODS
  This was a qualitative cross-sectional study. Data were collected between December 2012 and February 2013 in Sunamganj district of Sylhet division and data collection methods included key informant interviews (KII) with stakeholders; formal and informal health service providers and health managers; and in-depth interviews (IDI) with community women to capture a range of information. Key questions were asked of all the study participants to explore the question of why women and their families prefer home delivery by TBA and to identify the factors associated with this practice in the local community.
  
  
  RESULTS
  The study shows that home delivery by TBAs remain the first preference for pregnant women. Poverty is the most frequently cited reason for preferring home delivery with a TBA. Other major reasons include; traditional views, religious fallacy, poor road conditions, limited access of women to decision making in the family, lack of transportation to reach the nearest health facility. Apart from these, community people also prefer home delivery due to lack of knowledge and awareness about service delivery points, fear of increased chance of having a caesarean delivery at hospital, and lack of female doctors in the health care facilities.
  
  
  CONCLUSIONS
  The study findings provide us a better understanding of the reasons for preference for home delivery with TBA among this population. These identified factors can inform policy makers and program implementers to adopt socially and culturally appropriate interventions that can improve deliveries with skilled attendants and thus contribute to the reduction of maternal and neonatal mortality and morbidity in rural Bangladesh.
authors.affiliation: Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), GPO Box-1000, Dhaka, Bangladesh.
authors.forename: Bidhan Krishna
authors.initials: BK
authors.lastname: Sarker
authors.affiliation: Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), GPO Box-1000, Dhaka, Bangladesh.
authors.forename: Musfikur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), GPO Box-1000, Dhaka, Bangladesh.
authors.forename: Tawhidur
authors.initials: T
authors.lastname: Rahman
authors.affiliation: Care Bangladesh, Pragati Insurance Bhabhan, 20-21 Kawran Bazar, Level 9-13, Dhaka, 1215, Bangladesh.
authors.forename: Jahangir
authors.initials: J
authors.lastname: Hossain
authors.affiliation: Senior Associate and Deputy Director for Research, The Evidence Project, Population Council, Washington, District of Columbia, United States of America.|Former Director and Social Scientist, Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), GPO Box-1000, Dhaka, Bangladesh.
authors.forename: Laura
authors.initials: L
authors.lastname: Reichenbach
authors.affiliation: International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Dipak Kumar
authors.initials: DK
authors.lastname: Mitra
mesh_terms: D000328:Adult; D001459:Bangladesh; D003430:Cross-Sectional Studies; D005260:Female; D006268:Health Facilities; D006297:Health Services Accessibility; D006700:Home Childbirth; D006801:Humans; D008297:Male; D008427:Maternal Health Services; D008428:Maternal Mortality; D008880:Midwifery; D057240:Patient Preference; D011247:Pregnancy; D036301:Qualitative Research; D012424:Rural Population; D055815:Young Adult