title: A qualitative study on factors that influence women's choice of delivery in health facilities in Addis Ababa, Ethiopia.
abstract: Facility based delivery for mothers is one of the proven interventions to reduce maternal and neonatal morbidity and mortality. This study identified women's reasons for seeking to give birth in a health facility and captured their perceptions of the quality of care they received during their most recent birth, in a population with high utilization of facility based deliveries.
  
  
  
  This qualitative study was conducted in eight health centers in Addis Ababa. Women bringing their index child for first vaccinations were invited to participate in an in-depth interview about their last delivery. Sixteen in-depth interviews were conducted. Interviews were conducted by trained researchers using a semi-structured interview guide. The data were transcribed verbatim in Amharic and translated into English. A thematic analysis was conducted to answer specific study questions.
  
  
  
  All research participants expressed a preference for facility based delivery because of their awareness of obstetric complications, and related perceptions that facility-birth is safer for the mother and child. Dimensions of quality of care and the cost of services were identified as influencing decisions about whether to seek care in the public or private sector. Media campaigns, information from social networks and women's experiences with healthcare providers and facilities influenced care-seeking decisions.
  
  
  
  The universal preference for facility-based birth by women in this study indicates that, in Addis Ababa, facility based delivery has become a preferred norm. Sources of information for decision-making and the dimensions of quality prioritized by women should be taken into account to develop interventions to promote facility-based births in other settings.
authors.affiliation: Addis Continental Institute of Public Health, P.O Box 26571/1000, Addis Ababa, Ethiopia. Tigestshiferaw@gmail.com.
authors.forename: Tigest
authors.initials: T
authors.lastname: Shifraw
authors.affiliation: Addis Continental Institute of Public Health, P.O Box 26571/1000, Addis Ababa, Ethiopia.
authors.forename: Yemane
authors.initials: Y
authors.lastname: Berhane
authors.affiliation: Addis Continental Institute of Public Health, P.O Box 26571/1000, Addis Ababa, Ethiopia.
authors.forename: Hanna
authors.initials: H
authors.lastname: Gulema
authors.affiliation: Maternal Health Task Force, Harvard TH Chan School of Public Health, 651 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Tamil
authors.initials: T
authors.lastname: Kendall
authors.affiliation: Maternal Health Task Force, Harvard TH Chan School of Public Health, 651 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Austin
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology*; D005002:Ethiopia; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D036801:Parturition / Q000523:psychology*; D057240:Patient Preference; D011247:Pregnancy; D036301:Qualitative Research; D011787:Quality of Health Care; D055815:Young Adult
keywords: Birth preparedness; Institutional delivery; Maternal mortality; Pull factors; Safe delivery; Urban