This study investigated rural Lao PDR village women's views and experiences of
recent, or impeding, childbirth to better understand barriers to maternity service
usage. Lao PDR has the highest maternal mortality rate (MMR) in the South-East
Asian region with very low utilization rates for skilled birth assistance and health
sector delivery services. The study site, Sekong, a southern Lao province, was
lowest in the country on virtually all indicators of reproductive and maternal
health, despite several recent maternal health service interventions. The study's
aim was to gain a fuller understanding of barriers to maternity services usage to
contribute towards maternity services enhancement, and district and national
policy-making for progressing towards 2015 MDG 4 & 5 targets.
A descriptive cross-sectional study was used. First, face-to-face questionnaires
were used to collect demographic and reproductive health and health care
experience data from 166 village woman (120 with a child born in the previous
year, and 46 who were currently pregnant). In-depth individual interviews then
followed with 23 purposively selected woman, to probe personal experiences and
perspectives on why women preferred home birthing.
The majority of women had given birth at home, assisted by untrained birth
attendants (relatives or neighbours). While seventy percent had accessed some
antenatal services, postpartum follow-up attendance was very low (17 percent).
Limited finances, lack of access to transport and prior negative health service
experiences were important factors influencing women's decision making. Giving
birth at home was seen by many, not just as unavoidable, but, as the preferred
option.
Recent top-down maternal health initiatives have had little impact in this region.
Improving maternal and child-health strategies requires much greater community
participation and use of participatory action methodologies, to increase women's
engagement in policy and planning and subsequent usage of health service
developments.