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Understanding pathways leading to stillbirth: The role of care-seeking and care received during pregnancy and childbirth in Kabul province, Afghanistan.

Authors :
Christou A
Alam A
Sadat Hofiani SM
Rasooly MH
Mubasher A
Rashidi MK
Dibley MJ
Raynes-Greenow C
Source :
Women and birth : journal of the Australian College of Midwives [Women Birth] 2020 Nov; Vol. 33 (6), pp. 544-555. Date of Electronic Publication: 2020 Feb 21.
Publication Year :
2020

Abstract

Background: The underlying pathways leading to stillbirth in low- and middle-income countries are not well understood. Context-specific understanding of how and why stillbirths occur is needed to prioritise interventions and identify barriers to their effective implementation and uptake.<br />Aim: To explore the contribution of contextual, individual, household-level and health system factors to stillbirth in Afghanistan.<br />Methods: Using a qualitative approach, we conducted semi-structured in-depth interviews with women and men that experienced stillbirth, female elders, community health workers, healthcare providers, and government officials in Kabul province, Afghanistan between October-November 2017. We used thematic analysis to identify contributing factors and developed a conceptual map describing possible pathways to stillbirth.<br />Findings: We found that low utilisation and access to healthcare was a key contributing factor, as were unmanaged conditions in pregnancy that increased women's risk of complications and stillbirth. Sociocultural factors related to the treatment of women and perceptions about medical interventions deprived women of interventions that could potentially prevent stillbirth. The quality of care from public and private providers during pregnancy and childbirth was a recurring concern exacerbated by health system constraints that led to unnecessary delays; while environmental factors linked to the ongoing conflict were also perceived to contribute to stillbirth. These pathways were underscored by social, cultural, economic factors and individual perceptions that contributed to the three-delays.<br />Discussion: Efforts are needed at the community-level to facilitate care-seeking and raise awareness of stillbirth risk factors and the facility-level to strengthen antenatal and childbirth care quality, ensure culturally appropriate and respectful care, and reduce treatment delays.<br /> (Copyright © 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1878-1799
Volume :
33
Issue :
6
Database :
MEDLINE
Journal :
Women and birth : journal of the Australian College of Midwives
Publication Type :
Academic Journal
Accession number :
32094034
Full Text :
https://doi.org/10.1016/j.wombi.2020.02.012