Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691 (Online) Sch. J. App. Med. Sci., 2014; 2(2D):830-839 ISSN 2347-954X (Print) ©Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources) www.saspublisher.com Research Article Factors Affecting Choice of Place for Childbirth among Women’s in Ahferom Woreda, Tigray, 2013 Haftom Gebrehiwot Department of Midwifery, College of Health Sciences, Mekelle University, Ethiopia *Corresponding author Haftom Gebrehiwot Email: Abstract: Reduction of maternal mortality is a global priority. The key to reducing maternal mortality ratio is increasing attendance by skilled health personnel throughout pregnancy and delivery. However, delivery service is significantly lower in Tigray region. Therefore, this study aimed to assess factors affecting choice of place of child birth among women in Ahferom woreda. A community based cross-sectional study both quantitative and qualitative method was employed among 458 women of age 15-49 years that experienced child birth and pregnancy in Ahferom woreda, Ethiopia. Multi stage stratified sampling technique with Probabilities proportional to size was used to select the study subjects for quantitative and focus group discussions (FGDs) for the qualitative survey. Study subjects again were selected by systematic random sampling technique from randomly selected kebelle’s in the Woreda. Data was collected using structured interview questionnaire and analyzed using SPPS version 16.0. A total of 458 women participated in the quantitative survey. One third of women were age 35 and above, 118(25.8%) were aged between 25-29 years. 247(53.9%) of women were illiterate, and 58.7% of women choice home as place of birth and 41.3% choice health facilities. Women whose husbands illiterate were less likely to choice health facility as place of child birth when compared to women whose husbands were receive secondary education and above[AOR(95%CI).23(.173-.76)]. Regardless of women having health information; women who get health information about the benefit of institutional deliveries increase the probability of choosing health institution 3.6 times higher than those who did not get the information [COR,95% CI 17 (6.9-44.3)],& [AOR,95% CI 3.6 (1.017-12.7)]. Age of the respondents, women and husband education, attending ANC, having information on the benefit of health institution delivery, distance and provider approach towards laboring women were significant predictors for the choice of place of child birth. Therefore, government and other responsible bodies should make efforts to increase community based health education, awareness creation and improve better access to information for women regarding maternal health care services. Moreover, Tigray health bureau in collaboration with the woreda and other stakeholders should provide means of transport (ambulance) to encourage referral between communities and health care providers. Keywords: Child birth, women, factors, Ahferom woreda INTRODUCTION world and has fallen little if at all since 2001. Maternal Maternal mortality is one of the indicators in the mortality in Ethiopia is likely linked both to extremely millennium development goal that is raising concern in low utilization of skilled birth attendants, low facility achieving the set target of reducing the rate by three- delivery and to even lower use of emergency obstetric fourth by 2015. Women who die due to pregnancy- care. The 2005 Demographic and Health Survey found related causes are in the prime of their lives and are that only 25% of all Ethiopian mothers living in rural responsible for the health and well-being of their areas received any antenatal care from a health families. The World Health Organization (WHO) professional in their last pregnancy, 3% delivered in a estimates that about 536,000 women of reproductive health facility, and 0.3% delivered by Caesarean section age die each year from pregnancy related [3]. complications. Nearly all of these deaths (99%) occur in the developing world [1, 2]. Promoting delivery in health facilities is a core strategy to reduce maternal mortality in Ethiopia [4]. Ethiopia is predominantly rural, low-income country Choice and preference for childbirth location are not in Eastern Africa. The most recent estimate of merely a matter of women’s unrestricted ability to Ethiopia’s maternal mortality ratio of 676 per 100,000 specify preference and act accordingly, but are shaped live births, however, remains among the highest in the and modified by the tempering socio-economic effects 830 Gebrehiwot H ., Sch. J. App. Med. Sci., 2014; 2(2D):830-839 of the contextual environment in which they arise. They The sample of 458 women were determined using are likely to be at least partially determined by available single population proportion formula with 95% level of options, possibilities, and limitations on the realization confidence, 5% margin of error and Proportion of of preference [5]. deliveries attended by skilled birth personnel of Tigray region is 12% (EDHS, 2011). Adding non response rate Pregnancy is a wonderful and personal experience. of 10%, & multiplying by a design effect of 2 due to the There is no way to know how quickly one will progress multistage nature of the sampling method. The required through labor, what complications that may arise, and samples based on the usual formula were 462. what emotions one will go through during the process. Some of the complications that arise during child birth Multi stage stratified sampling technique with can be avoided simply by making the right choice in Probabilities proportional to size was used to select the terms of preferred place of child birth [6, 7]. study subjects for quantitative and focus group discussions (FGDs) for the qualitative survey. Kebeles Moreover, there is no tangible study that has been were selected by simple random sampling, and the done in the woreda to explore the determinants of sample size was distributed to Kebeles by population institutional delivery. proportion to size (PPS) formula. Then, the households in the selected Kebeles were selected by using Thus, therefore, the aim of this study is to elucidate systematic sampling procedure with a random start. the factors that determine women’s choice of place of child birth in Ahferom woreda, Tigray regional state, Qualitative Survey Ethiopia. Purposive sampling was used to select respondents from four Kebeles for a focus group discussion. A METHODS series of two focus group discussions were conducted. Study area and period The recruitment of the participants was assisted by the The study was conducted from February to October, chairpersons of the kebeles. The study participants had in Ahferom woreda, Tigray Regional state, Northern who practice delivery and pregnancy. Ethiopia, situated about 960 km North of Addis Ababa. Data Collection and Analysis Ahferom is one of woredas in the Tigray Region of Quantitative survey Ethiopia. Part of the Mehakelegnaw Zone, The Structured questionnaire which was prepared in administrative center of this woreda is Enticho; Enticho English and translated by language teacher to the local is bordered on the south by Werie Lehe, on the language Tigrigna used to collect data. Household southwest by Adwa, on the west by Mereb Lehe, on the census was done by trained health extension workers north by Eritrea, and on the east by the Misraqawi and interview was done by trained midwives after (Eastern) Zone. training is given to them. Based on the 2007 national census conducted by the The questionnaires were checked for completeness, Central Statistical Agency of Ethiopia (CSA), this coded and entered into SPSS version 16 software woreda has a total population of 173,700, an increase of package for cleaning and analysis. Crude & adjusted 32.43% over the 1994 census, of whom 84,014 are men odds ratio were used to control the possible and 89,686 women; 23,421 or 13.48% are urban confounding variables. inhabitants. With an area of 2,367.84 square kilometers, Enticho has a population density of 73.36, which is Qualitative survey greater than the Zone average of 56.29 persons per Focus group discussion (FGD) was chosen as the tool square kilometer. A total of 38,934 households were for data collection. It aimed to explore and to share the counted in this woreda, resulting in an average of 4.46 experiences, thoughts, feelings, attitudes and ideas of persons to a household, and 37,483 housing units. participants on determinants to choice of place of child birth. Two series of FGDs were held by 18 women who Study Design and Population were volunteered and one TBA and one TTBA each A descriptive community based cross sectional study contained 10 participants. The group members were not which employed both quantitative and qualitative knows each other and homogenous in terms of gender method was used. and fulfilled inclusion criteria. Before the FGDs, the moderator introduced all participants, explained the All women of child bearing age groups who had general purpose of the study and topic of the experience in pregnancy and delivery were included in discussions. The participants were informed about the the study while women who were never been pregnant, tape-recorder and permission to be recorded was who weren’t physically and mentally capable to be requested. Informed verbal consent was obtained from interviewed were excluded from the study. all individuals participating in the discussion. Then, participants’ conversations were audio taped, Sample size and sampling technique transcribed verbatim and translated. 831 Gebrehiwot H ., Sch. J. App. Med. Sci., 2014; 2(2D):830-839 RESULTS primary source of information were friends or Quantitative results of respondents neighbors and 60(13.1%) of them said media (Table - A total of 458 women age 15-49 years who had 3). experience pregnancy and delivery were participated in the study with 99.1% response rate. One third of All the participants responded that the presence of women were age 35 and above, 118(25.8%) were aged health unit which gives delivery service in their between 25-29years.