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"In the Hospital, There Will Be Nobody to Pamper Me": A Qualitative Assessment on Barriers to Facility-Based Delivery in post-Ebola Sierra Leone


"In the Hospital, There Will Be Nobody to Pamper Me": A Qualitative Assessment on Barriers to Facility-Based Delivery in post-Ebola Sierra Leone

Stefanie Theuring et al. Reprod Health.


Background: Sierra Leone has one of the highest maternal mortality rates in the world. Encouraging the use of skilled birth attendance in health facilities is an important step in the endeavor to increase the number of safe deliveries. However, public trust in health facilities has been greatly damaged during the Ebola epidemic outbreak in Sierra Leone in 2014/2015, and little is known about external and intrinsic barriers to facility-based delivery (FBD) in the country since the end of the Ebola epidemic.

Methods: We conducted a qualitative study on FBD in Princess Christian Maternity Hospital, Freetown, which is the national referral maternity hospital in Sierra Leone. We performed six focus group discussions with providers, pregnant women and recent mothers surrounding experiences, attitudes and behaviors regarding FBD and potential barriers. Discussions were tape recorded, transcribed and evaluated through content analysis.

Results: Women in our study were overall technically aware of the higher safety linked with FBD, but this often diverged from their individual desire to deliver in a supportive and trusted social and traditional environment. Close relatives and community members seemed to be highly influencial regarding birth practices. Many women associated FBD with negative staff attitudes and an undefined fear. Logistic issues regarding transportation problems or late referral from smaller health centers were identified as frequent barriers to FBD.

Conclusions: More supportive staff attitudes and acceptance of an accompanying person throughout delivery could be promising approaches to increase women's confidence in FBDs. However, these approaches also imply revising health systems structures, like staff working conditions that are conducive for a friendly atmosphere, sufficient space in delivery wards allowing the women to bring a birth companion, or like the establishment of a reliable peripheral ambulance system to ensure transportation and fast referral.

Keywords: Facility-based delivery; Maternal mortality; Post-Ebola; Qualitative study; Sierra Leone.

Conflict of interest statement

Ethics approval and consent to participate

Permission to conduct this assessment was granted by the PCMH executive board. This was a preparatory assessment for further formative research on increasing FBD rates, so need for further ethical approval was waived at this stage. All information resulting from the discussions was treated strictly confidential, and data was anonymized during transcription and analysis procedures. Participants were free to choose which questions they wanted to answer or discuss, they were not pressurized to give any statement and they could withdraw their data at any moment without negative consequences for their treatment in PCMH.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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