Strategies to Improve Facility-based Attendance of Skilled Birth Among Slum Residents, Addis Ababa, Ethiopia: a Qualitative Study.
Authors: Sendo Endalew Gemechu , Chauke Motshedisi E. , Ganga-Limando M 
Published: March 2021

Abstract
Background: Global strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery along with access to emergency obstetric care. Research that examines strategies to increase facility-based skilled birth attendance among slum residents in Addis Ababa, Ethiopia, is limited.Objective: The objective of the study was to explore women’s views on measures needed to enhance the utilization of health facility-based delivery services. Methods: A qualitative exploratory and descriptive research design was used. The design was contextual. Participants in the study were women in the reproductive age group (18-49 years of age) living in the slum areas of Addis Ababa, Ethiopia. A purposive sampling strategy was used to select study participants. Four audio-recorded Focus Group Discussions [FGDs] were conducted with 32 participants from the three public health centers chosen and one district hospital. The number of participants in FGDs was between 6 to 10 women. Data were analyzed simultaneously with data collection. Thematic analysis was done for the study. The qualitative data were analyzed in three phases: exploring and creating initial codes; searching for themes by collecting coded data addressing particular themes, and identifying and naming themes found. To explain the study results, verbatim excerpts from participants were given. The researcher used Techs' eight steps of qualitative data analysis method for analysing the data. The analysis involved the use of both a priori codes (from the question guide) and emergent inductive codes. A multi-level life-course framework of facility-based delivery in low- and middle-income countries (LMICs) developed by Bohren, et al was used to frame the current study and link the findings of the study to the body of knowledge. Results: The Focus Group Discussions included a total of 32 participants. The mean age of the overall sample was 32.6 years (±SD = 5.2). Participants' educational characteristics indicate that the majority (24 out of 32) was found to have no formal education, and two-thirds of participants were found to have one to five children. Three-fourths of them attended the ANC twice and they all gave birth to their last child at home. Two themes emerged from the analysis of focus group interviews data, namely provision of quality, respectful and dignified midwifery care, and increased awareness of FANC. These themes were described as a rich and comprehensive account of the views and suggestions made by FANC participants on measures required to improve the use of delivery services based on health facilities. The findings of the study raise concerns about the effectiveness of FANC in encouraging facility-based deliveries since FANC participants had not used health facilities for their last childbirth. According to the findings of the focus groups, women who took part in this study identified measures required to increase the use of health facility-based delivery services among FANC participants in Addis Ababa's slum residents. It is to be expected that diligent counseling during antenatal care about birth plans would facilitate prompt arrival at facilities consistent with the desires of women.