title: Is home delivery really preferred? a mixed-methods national study in Pakistan.
abstract: BACKGROUND
  Pakistan has a high maternal mortality ratio and a low rate of skilled birth attendants (SBAs). To address these two important issues, the Pakistan Maternal Newborn and Child Health (MNCH) programme launched the community midwives (CMW) initiative in 2007. CMWs are supposed to conduct deliveries at community level outside health facilities. The purpose of the current study is to document perceptions about CMWs and preferences for birthing place.
  
  
  METHODS
  A mixed-methods study was conducted covering four provinces. For the quantitative survey, households were selected through a multistage sampling technique from rural districts. In 1,450 rural households, preferences of respondents about CMW-conducted deliveries were recorded. Qualitative data were obtained through focus group discussions (FGDs) and in-depth interviews (IDIs) with women, community elders, CMWs, and MNCH programme personnel in the same areas where the quantitative study was carried out. In both studies, preferences and the reasons behind particular respondent preferences were recorded. Frequencies of responses were analysed for the quantitative study. Narration and quotes from various types of participants were used to present findings from FGDs and IDIs.
  
  
  RESULTS
  In the quantitative study, 42% of respondents expressed a preference for birthing stations, i.e. a place where CMWs conduct deliveries; 22% preferred home deliveries. Birthing stations were favoured because of the availability of space and equipment and the proximity to women's homes. These findings were largely supported by the qualitative component, although a range of views about where a CMW should conduct deliveries were expressed.
  
  
  CONCLUSIONS
  Insights into where CMWs might provide delivery services were obtained through this study. Birthing stations may be an option as a preferred location for delivery care and should be considered as part of Pakistan's national CMW programme.
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. shamsa_zafar@hotmail.com.|, Hno 9 B, Street 31, F8/1, Islamabad, Pakistan. shamsa_zafar@hotmail.com.
authors.forename: Shamsa
authors.initials: S
authors.lastname: Zafar
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. siham.sikander@hdrfoundation.org.
authors.forename: Siham
authors.initials: S
authors.lastname: Sikander
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. ikhlaq.malik@hdrfounfatiom.org.
authors.forename: Ikhlaq
authors.initials: I
authors.lastname: Ahmad
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. mansoorahmad71@msn.com.
authors.forename: Mansoor
authors.initials: M
authors.lastname: Ahmad
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. nazia.malik@hdrfoundation.org.
authors.forename: Nazia
authors.initials: N
authors.lastname: Parveen
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. shumaila.saleem@hdrfoundation.org.
authors.forename: Shumaila
authors.initials: S
authors.lastname: Saleem
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. tayyba.nawaz.awan@hdrfoundation.org.
authors.forename: Tayyba
authors.initials: T
authors.lastname: Nawaz
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. zainab.suleman@hdrfoundation.org.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Suleman
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. nadia.suleman@hdrfoundation.org.
authors.forename: Nadia
authors.initials: N
authors.lastname: Suleman
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. noor.ul.ain@hdrfoundation.org.
authors.forename: Noor
authors.initials: N
authors.lastname: ulAin
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. ayesha.naeem@hdrfoundation.org.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Naeem
authors.affiliation: Human Development Research Foundation, Islamabad, Pakistan. asmabasheer2@gmail.com.
authors.forename: Asma
authors.initials: A
authors.lastname: Bashir
mesh_terms: D001294:Attitude to Health; D016550:Birthing Centers; D036861:Delivery, Obstetric; D005191:Family Characteristics; D005260:Female; D017144:Focus Groups; D006078:Government Programs; D006282:Health Personnel; D006700:Home Childbirth; D006801:Humans; D008427:Maternal Health Services; D008428:Maternal Mortality; D008880:Midwifery; D010154:Pakistan; D011247:Pregnancy; D019035:Rural Health Services; D012424:Rural Population; D011795:Surveys and Questionnaires