Aim and objective: The general aim of this research was to explore why women do or do not
want to uptake Skilled Birth Attendants’ (SBAs) services during childbirth. The objective
was to explore the factors affecting the uptake of SBAs’ services during childbirth in rural
Nepal.
Methods: Semi-structured interviews were conducted. The data were analysed using thematic
analysis.
Setting: The fieldwork was conducted in a rural area, in a western hill district of Nepal.
Participants: Interviews were conducted with 24 married women aged 18-49, who had given
birth during the three years prior to the time of interview. Sixteen women were SBA users
and eight were non-SBA users. Eight relatives, such as husbands, and parents-in-law were
also interviewed as key informants.
Findings: Four themes were identified as affecting the uptake of skilled care during
childbirth: (1) Women’s individual characteristics; (2) Choice of, and access to, SBA
services; (3) Cultural practice, gender role and decision making; and (4) Attitude and quality
of SBAs and the hospital environment.
Conclusion: A wide range of factors affect the uptake of SBAs services. These include: lack
of SBAs in rural areas; women’s autonomy; difficult terrain; widespread poverty and
illiteracy; limited resources and traditional and cultural attitudes; and gender factors.
However, to date, women’s experiences and preferences have been overlooked in service
design and development. There is a need for specific maternity service development, based
on women’s experiences and perceptions. The establishment of a fully trained cadre of midwives, operating according to a professional code of ethics, could improve the quality of
care in the existing health care facilities.