Making Choices for Safer Deliveries: A Grounded Theory Analysis of Women's Experiences of Delivery Care in Northern Ethiopia

In 2003, the Ethiopian Ministry of Health launched the Health Extension Programme (HEP), aimed to increase access to reproductive health care. Despite an enormous effort, access to maternal health services remains limited, and the reasons for this are still unclear. This study explores women’s experiences and perceptions regarding delivery care in Tigray, a northern region of Ethiopia. By elucidating this, we will be able to point out suggestions for better implementation of maternal health care services in this setting. We used six focus group discussions with 51 women to explore perceptions and experiences regarding delivery care. The data were analyzed using grounded theory and one category emerged “making choices for a safer delivery” which represents how women in this setting struggled for a safer delivery making choices between two available models of childbirth. On the one hand, home delivery, represented by the category “embedded in tradition” - related to their faith, the ascendency of elderly women, advantages of staying at home and the custom of traditional birth attendants (TBAs). On the other, institutional delivery, represented by the category “medical knowledge under constrained circumstances”- and linked to how women appreciated medical resources and support of health extension workers (HEWs) but were uncertain about the quality of care, and emphasized the obstacles for transportation. In Tigray women were making choices pragmatically and seemed to not feel any conflict between the two available models, being supported by traditional birth attendants, HEWs and husbands in their decision-making. However, the two models were not as open to collaboration as the women themselves. The HEP would benefit from an approach that incorporates all the actors involved in maternal care, both at the institutional, community and family level. Reconsideration on the role of TBAs, and a well-designed, community inclusive, coordinated and feasible referral system should be maintained.