Reasons for underutilization EmOC Services

One of the four main components of safe motherhood initiative is provision of EmOC. Cognizant of this fact, ESOG in collaboration with FIGO and Oromia regional health bureau started ‘save the mothers’ activities at project level. During the course, it was found out that EmOC utilization in west Shoa zone was less than 2%. Considering the condition, ESOG felt that it is imperative to explore factors that contribute to this underutilization of EmOC services.

To address this concern, a rapid, easy, less expensive qualitative method with triangulation of FGD and in-depth interview was conducted. The participants were female and male residents of the project areas as well as representatives of women affairs office representatives and longest serving providers in the labor and delivery unit. Trained nurse midwives and staff nurses facilitated the FGD. The investigators (project coordinators) conducted the in-depth interview.

Because the nature of the problem is complex, the number and level of participants included are diverse the results are found to be delicate, intricate, complex and interesting. Generally, the reasons for under utilization of EmOC as summarized in the model fall in three categories (figure 1).

Figure 1. Reasons for underutilization of EmOC services in selected woredas of west Shoa zone of Oromia region, Ethiopia.

Based on the findings the following conclusions were made and recommendations forwarded.

The key factors underlined for the health seeking behavior of this community are lack of education, low income, not knowing availability of delivery services, distance of institutions together with poor infrastructure like road and transportation, institutional related problems as well as traditional factors.

Women do not know the availability of modern obstetric care. Disseminating the obstetric services given in the institutions through gatherings for religious and social affairs and during community field works is recommended. 

Conservative traditional attitudes still exert their influence on EmOC service utilization. In addition, fear and misconceptions about procedures done during labor and delivery exist. Sensitization and awareness creation to change these thoughts by teaching the community can improve utilization.

Some health providers do not have positive attitude towards clients. Facilitative supervision and monitoring together with recognizing and appreciating efforts of the technical personnel can be made at no additional cost.

Women educational status is very low. The community does not acknowledge women education. Encouraging parents to send their daughters to school and allowing them to pursue their education through appropriate authorities will bring a change with time.

Clearly expressing the benefits of modern delivery services and FP will be helpful in alleviating men’s unnecessary concern related with hospital delivery. Since they are the “decision makers” involving them is emphasized.

Golebe and Idir, where they exist, were found to have a strong influence on promoting service delivery by making available loans and organizing people to help in transporting laboring women. Their contribution in these efforts shall be encouraged and appreciated. Encouraging communities to establish these self-help organizations in areas where they don’t exist is recommended.

Culturally accepted gender discrimination in favor of males start at birth. Women in the countryside have low status. Decision in matters of property is also considered exclusively a male affair because of erroneous belief. Familiarizing the law and order of the land in matters related to property ownership can help both men and women to this effect.