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Who decides where women give birth and on what grounds?

Posted: 22 Sep 2015
The traditional medical view of risks associated with giving birth sometimes clashes with what women themselves perceive.

In the Netherlands, some women go against medical advice in choosing high-risk homebirths, because they consider the biomedical model of birth as being risky. They see it as a model in which they have less autonomy and free choice (and in which more intervention during labour is required). In this case, home is seen as a safer haven than the health system. (Study by Lianne Holten from VU University Amsterdam)

While actors in the health system are only required to consider the risks associated with the delivery itself, in Malawi, women are faced with a number of complications to consider and manage when deciding whether to give birth at home or at a hospital (e.g. family responsibilities, distance to facility, etc.). In order to improve safer motherhood messages it is important to understand how the women themselves perceive risk. (Research by Isabelle Uny - Queen Margaret University)

statue of pregnant woman

Photo: Chris Goldberg (CC BY-NC 2.0)

Similarly, women in Rwanda have multiple concepts of risk in pregnancy and use both biomedical and traditional methods to address these risks. Again, the government needs to keep these are considerations in mind. Rwanda may have reduced maternal mortality rates by two thirds in 10 years through strong government policies, but the way in which these have been delivered is sometimes seen as being disempowering and counterproductive. (Research by Frances Haste)

In Manitoba, a remote community in Canada, pregnant women are evacuated to a larger city in order to give birth at 37 weeks. These women and their home environments are constructed as high risk by the government, which can be considered a very technocratic view of birth. The women face a number of non-medical issues during their stay in this town (e.g. isolation, etc.) which also need to be taken into account. (Study by Rachel Olson -The Firelight Group).

These cases show that reproductive health is conceptualised differently in household decision-making and in the health policy discourse. They were presented as part of a panel on ‘Maternal precarity is at the intersection of households and health systems’ at the MAGic2015 conference on ‘Anthropology and Global Health: interrogating theory, policy and practice’ . This conference took place at the University of Sussex from 9-11th September 2015 and aimed to interrogate the paradigms and practice of global health.

A myriad of topics were discussed at the conference. One of the key topics for discussion was the ebola epidemic. The conference started with a plenary session on the topic and included various panels stressing the importance of a community-based and community-led Ebola response. Other topics discussed include: chronicity and urbanisation, health and policy.

Further Reading

Why women choose to give birth at home: a situational analysis from urban slums of Delhi
N. Devasenapathy; M. S. George; S.G. Jerath / British Medical Journal 2014
Better understanding the factors influencing home or institutional birth among the urban poor is needed in order to enhance programme impact. This paper aims to measure the prevalence of home and institutional births in an urban slum ...
Helpdesk Report: Increasing facility - based deliveries and providing referral transport for women in childbirth in Asia
Health and Education Advice and Resource Team 2014
This report looks at approaches to increasing the proportion of baby deliveries which take place in health facilities, and the provision of referral transportation for women and childrento access healthcare for childbirth and for emer...
Community engagement in health service delivery
Health and Education Advice and Resource Team 2011
What evidence is there to show that community participation and accountability in health service delivery leads to improved access to quality health services, improved health outcomes, increased government ownership/responsibility, an...
Provision and use of maternal health services among urban poor women in Kenya: what do we know and what can we do?
J.C. Fotso; A. Ezeh; R. Oronje / PubMed Central 2008
In sub-Saharan Africa, the unprecedented population growth that started in the second half of the twentieth century has evolved into unparalleled urbanisation and an increasing proportion of urban dwellers living in slums and shanty t...
Complications of childbirth and maternal deaths in Kinshasa hospitals: testimonies from women and their families
BMC Pregnancy and Childbirth 2011
Maternal mortality in Kinshasa is high despite near universal availability of antenatal care and hospital delivery. Possible explanations are poor-quality care and delays in the uptake of care. There is, however, little information on...
Challenges to maternal health care utilisation among ethnic minority women in a resource-poor region of Sichuan Province, China
A. Harris; Y. Zhou; H. Liao / Oxford Journals 2010
A goal of the Chinese government is to improve the quality and use of maternity services. This paper presents a simple descriptive study of maternal health care utilisation (MHCU) among ethnic minority women in a remote region of Chin...
Birth preparedness for maternal health: findings from Koupela district, Burkina Faso
A. C. Moran; G. Sangli; R. Dineen / International Centre for Diarrhoeal Disease Research, Bangladesh 2006
This paper assesses the impact of birth-preparedness and complication readiness on the use of skilled providers at birth, a key intervention to decrease maternal mortality. It is based on a study of a district-based service delivery s...
How do village women determine foetal status and foetal pose in Malawi?
C. Maliwichi-Nyirenda; L. Maliwichi / Chancellor College, University of Malawi 2010
In Malawi, 80% of the population lives within 8 km radius of a health care facility. However, most facilities lack drugs, personnel and laboratory equipment. Due to poverty, people cannot afford private hospital services, hence resort...
Women's perceptions of homebirths in two rural medical districts in Burkina Faso: a qualitative study
T. D. Some / Reproductive Health 2011
In developing countries, most childbirth occurs at home and is not assisted by skilled attendants. The situation increases the risk of death for both mother and child and has severe maternal complications. The purpose of this study wa...

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