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‘I was trying to get there, but I couldn’t’: social norms, vulnerability and lived experiences of home delivery in Mashonaland Central Province, Zimbabwe

Webb, K, Mavhu, Webster ORCID: https://orcid.org/0000-0003-1881-4398, Langhaug, L, Chitiyo, V, Matyanga, P, Charashika, P, Patel, D, Prost, A, Ferrand, R, Bernays, S, Cislaghi, B and Neuman, M (2021) '‘I was trying to get there, but I couldn’t’: social norms, vulnerability and lived experiences of home delivery in Mashonaland Central Province, Zimbabwe'. Health Policy and Planning, czab058. (In Press)

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Abstract

Increasing facility-based delivery rates is pivotal to reach Sustainable Development Goals to improve skilled attendance at birth and reduce maternal and neonatal mortality in Low- and Middle-Income Countries (LMICs). The translation of global health initiatives into local policy and programs has increased facility-based deliveries in LMICs, but little is known about the impact of such policies on social norms from the perspective of women who continue to deliver at home. This qualitative study explores the reasons for and experiences of home delivery among women living in rural Zimbabwe. We analysed qualitative data from 30 semi-structured interviews and five focus group discussions with women who had delivered at home in the previous six months in Mashonaland Central Province. We found evidence of strong social norms in favour of facility-based delivery. However, despite their expressed intention to deliver at a facility, women described how multiple, interacting vulnerabilities resulted in delivery outside of a health facility. The majority of women in our study delivered ‘on the road’, en route to the health facility. Strong norms for facility-based delivery created punishments and stigmatisation for home delivery, which introduced additional risk to women at the time of delivery and in the postnatal period. These consequences for breaking social norms promoting facility-based delivery for all further increased the vulnerability of women who delivered at home or on the road. Our findings highlight that equitable public health policy and program design should include efforts to actively identify, mitigate and evaluate unintended consequences of social change created as a by-product of promoting positive health behaviours and universal coverage of health service uptake among those most vulnerable who are unable, or unwilling, to comply.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WQ Obstetrics > Childbirth. Prenatal Care > WQ 155 Home childbirth
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1093/heapol/czab058
Depositing User: Rachel Dominguez
Date Deposited: 01 Jul 2021 11:19
Last Modified: 01 Jul 2021 11:19
URI: https://archive.lstmed.ac.uk/id/eprint/18143

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