A Culturally Sensitive and Supportive Maternity Care Service Increases the Uptake of Maternity Waiting Homes in Ethiopia.

BACKGROUND: Maternal delays in utilization of emergency obstetric care are impacting on a high maternal mortality, especially in the poor resource countries including Ethiopia. Different strategies are designed and employed to reduce those maternal delays, and one of such strategies employed to overcome the geographic barriers and improve maternal and neonatal health outcomes is utilization of maternity waiting homes (MWHs). Studies related to the utilization of MWHs and associated factors are limited in Ethiopia and there were none in the study area. OBJECTIVE: The aim of this study was to assess the utilization of maternity waiting homes and associated factors. METHODS AND MATERIALS: A community-based cross-sectional study design was conducted, using multistage sampling technique. Logistic regression analysis with 95% CI for odds ratio (OR) was used to identify significant factors. RESULTS: A total of 379 women participated in this study, making a response rate of 85%. Of the total participants, 42.5% (95% CI=38-48) of women utilized MWHs. After controlling for potential confounders, women's decision-making capacity (AOR=12.74; 95% CI=6.18-26.26), women having someone who can care for their children and/or husband at home (AOR=2.71; 95% CI=1.44-5.09), MWHs offering food service (AOR=4.03; 95% CI=2.07- 7.85), offering and/or allowing women to practice their own cultural ceremony (allowing to cook their own food type, porridge, coffee, etc) (AOR=9.55; 95% CI=4.45-20.47), and women's attitude towards MWHs (AOR=0.09; 95% CI=0.03-0.23) were factors significantly associated with the utilization of MWHs. CONCLUSION: Compared to its contribution in reducing maternal and perinatal mortality, the utilization of MWHs was low in this study area. The integration of culturally sensitive and supportive maternity services, along with community participatory approach, would increase utilization of MWHs and consequently contribute in achieving the SDGs related to maternal and neonatal health.

Ethiopian Health Care Workers' Insights into and Responses to Intimate Partner Violence in Pregnancy-A Qualitative Study.

Violence against women is a global pandemic, with the potential to spread through generations. Intimate partner violence has impacts on women's sexual, reproductive, and psycho-social health. It can occur during pregnancy and adversely affect the health of both mother and child. Health care workers involved in antenatal care can have a unique role in identifying intimate partner violence and in intervening, preventing, and mitigating its consequences. In this study, the objective was to explore Ethiopian health care workers' insights of and responses to intimate partner violence in pregnancy. Using an exploratory design, this qualitative study includes ten semi-structured interviews of health care workers representing different antenatal care centers in Jimma, Ethiopia. The content analyses of translated interview notes were conducted with Atlas.ti7 software, (Atlas.ti Scientific Software Development Gmbh, Berlin). The health care workers shared their insights of the consequences of intimate partner violence during pregnancy in addition to their experience with and responses to the victims. There was a limited understanding of the extent of the adverse impacts of intimate partner violence on pregnancy outcomes, as well as the potential long-term health implications. The informants described how they only gave medical treatment for obstetric complications or visible trauma during pregnancy. There was no formal referral to or linkages with other resources. Women's empowerment and systemic changes in the health care, including training and capacity building, clear guidelines addressing management of intimate partner violence in pregnancy, and inclusion of intimate partner violence screening tools in the Ethiopian antenatal care chart/card, were recommended by the informants. The adverse impacts of intimate partner violence on pregnancy outcomes were poorly understood by the Ethiopian health care workers in this study. They offered limited assistance to the victims and recommended changes in the routine antenatal care (ANC) and health care systems. They identified various policy initiatives focusing on women's empowerment to reduce intimate partner violence and its complications especially during pregnancy.

Community Stakeholders' Perspectives on Intimate Partner Violence during Pregnancy-A Qualitative Study from Ethiopia.

Intimate partner violence (IPV) in pregnancy adversely affects the health of women and unborn children. To prevent this, the community responses, societal systems, and structures to support victims of IPV in pregnancy are vital. OBJECTIVES: to explore community stakeholders' perspectives related to IPV in pregnancy in Jimma, Ethiopia, and if needed, create the knowledge base for interventions. METHODS: using an exploratory design, this qualitative study had a maximum-variation (multiple spectrum sources) sampling strategy with 16 semi-structured interviews of purposively selected key informants representing different community institutions. Guided by Connell's theory of gender and power, a content analysis of the translated interviews was conducted using Atlas.ti 7 software. RESULTS: reconciliation between IPV victims and their abusers was the solution promoted by almost all the respondents. There was limited awareness of the adverse impacts IPV in pregnancy has on the health of the woman and the foetus. Despite regular encounters with victims, there is no organized or structured operational response to support IPV victims between the participating institutions. CONCLUSION: the potential danger of IPV for the mother or the unborn child was not well understood by the members of the studied Ethiopian community. Neither coordinated efforts to support IPV victims nor links among relevant agencies existed. The study demonstrated the dire need of coordinated practical action, changes in current socio-cultural norms, formal training and capacity building, awareness creation, clear intervention guidelines, and facilitation of support networks among relevant institutions in Ethiopian communities.

Intimate partner violence and late entry into antenatal care in Ethiopia.

BACKGROUND: Utilization of maternal health care services and timely initiation of antenatal care (ANC) positively influence pregnancy outcomes. The prevalence of intimate partner violence (IPV) during pregnancy is very high in Ethiopia, but we have limited knowledge on the link between IPV and initiation of ANC. AIM: To determine the association between IPV and late entry into ANC. METHODS: A cross sectional study was conducted among pregnant women attending ANC at the governmental health institutions. A total of 720 pregnant women were interviewed by five trained nurses or midwives, using standardized and pretested questionnaire. Descriptive, bivariate and multivariate logistic regression and parity-stratified analyses were employed. FINDINGS: Over half of the pregnant women (51.8%; 95% CI=48.1, 55.5) entered ANC late (>16 weeks). Controlling for demographic, behavioural and reproductive health related variables, among multiparous women, any lifetime emotional or physical abuse was associated with late ANC [Adjusted odds ratio (AOR)=2.28; 95%CI=1.18, 4.39]. However, reporting recent experience of partner sexual violence was associated with late ANC in the full sample (AOR=1.55; 95%CI=1.09, 2.19). CONCLUSION: The proportion of pregnant women entering ANC late is high in Ethiopia and associated with prior and recent experience of IPV in the current pregnancy, especially among multiparous women. Efforts for preventing IPV in pregnancy are needed to ensure that all pregnant women initiate ANC early in pregnancy. Aims of improving the health sector responses should include training health care workers on IPV that could facilitate ongoing screening, awareness creation, and women's social support networks.

Social ecological factors and intimate partner violence in pregnancy.

BACKGROUND: Intimate partner violence (IPV) during pregnancy increases adverse pregnancy outcomes. Knowledge of societal, community, family and individual related factors associated with IPV in pregnancy is limited in Ethiopia. Our study examined these factors in an Ethiopian context. MATERIALS AND METHODS: A cross sectional study was conducted among pregnant women attending antenatal care at governmental health institutions, using a consecutive probability sampling strategy. A total of 720 pregnant women were interviewed by five trained nurses or midwives, using a standardized and /pretested survey questionnaire. Bivariate and multivariate logistic regression analyses were applied to assess factors contributing to IPV. We used Akaike's information criteria, to identify the model that best describes the factors influencing IPV in pregnancy. RESULTS: Among the women interviewed, physical IPV was reported by 35.6%, and lifetime emotional or physical abuse by 81.0%. Perceiving violence as a means to settle interpersonal conflicts, presence of supportive attitudes of wife beating in the society, regarding violence as an expression of masculinity, and presence of strict gender role differences in the society, were all positively associated to IPV in pregnancy. The presence of groups legitimizing men's violence in the community, feeling isolated, having no social support for victims, and presence of high unemployment, were the perceived community related factors positively associated with IPV in pregnancy. CONCLUSION: IPV in pregnancy is very prevalent in Ethiopia and is associated with multiple social ecologic factors. Reduction of IPV in pregnancy calls for cross sectorial efforts from stakeholders at different levels.

Factors associated with utilization of emergency contraception among female students in Mizan-Tepi University, South West Ethiopia.

BACKGROUND: Unintended pregnancy poses a major health problem on female students in higher educations. One of the key interventions to reduce unintended pregnancy and unsafe abortion as outlined in the national youth strategy is making emergency contraception (EC) available for these risky population. However, despite its availability in many countries, EC has failed to have the desired impact on unintended pregnancy rates and its utilization is limited in colleges and universities. The objective of this study was to assess factors associated with utilization of emergency contraception among female students in Mizan-Tepi University (MTU), south west Ethiopia. METHODS: A cross-sectional, institution based study was conducted from March 10-30, 2014. Multistage sampling technique was used to select the participants for the quantitative method whereas; purposive and volunteer sampling techniques were used for the qualitative study. Quantitative data were cleaned, coded and entered into Epi-data 3.1 and analyzed using SPSS version 20:00. Binary and multiple logistic regression analysis were done to determine the association between the use of EC and the predicator variables. Data from focus group discussion were transcribed and translated to English then coded, and categorized into similar themes. RESULT: A total of 489 female students were participated in the quantitative study making a response rate of 90.6%. The finding shows that 46.3% of them have used EC following unprotected sex. Female students' knowledge about EC [AOR: 3.24; 95% CI 1.32, 7.98], age at first sexual intercourse (i.e. ≥20 years) [AOR: 4.04; 95% CI 1.72, 9.52], history of pregnancy [AOR: 3.12; 95% CI 1.34, 7.24] and previous use of regular contraceptives [AOR: 5.01; 95% CI 2.23, 11.27] were found to be significant predictors of EC utilization. In the focused group discussion, a total of 32 female students were participated and the result shows that lack of knowledge about EC and fear of being seen by others (information disclosure) were reported as main factors for not using EC. CONCLUSION: The study shows that the level of EC use was low. Female students' level of knowledge about EC, age at first sexual intercourse, previous use of regular contraceptives and history of pregnancy were major predictors of EC utilization. Therefore, designing strategies to enhance EC utilization by increasing female students' level of awareness on EC is recommended.