The topic of home birth is often a contentious one, sometimes causing heated debates among researchers, clinicians and advocates. While advocacy efforts around home birth—typically in high-income countries—tend to center on women’s rights to choose where they will have their babies, it is important to remember that home birth is not always a choice. Particularly in low-resource settings, women sometimes deliver at home not because they want to, but because they have to.
Several studies have examined barriers to facility-based delivery. The groundbreaking “three delays” model proposed by Thaddeus and Maine in 1994 provided a framework for understanding why women may not deliver at a health facility. Geographic and socioeconomic inequities in access to facility-based delivery exist across the globe, reflecting the reality that some women are more likely to have a skilled birth attendant and essential supplies when they give birth than others.
A recent paper that was published in the MHTF-PLOS Collection, “Neglected Populations: Decreasing Inequalities & Improving Measurement in Maternal Health,” presented perspectives from women in rural West Bengal, India who delivered either at home or in a health facility. Researchers conducted twelve focus groups with nearly 100 women in an effort to understand the factors influencing delivery location.
Among the 55 women who delivered at home, 33 (60%) said that they had preferred to do so in a health facility. One of the barriers discussed was the unwillingness of family members to accompany women to the health facility.
“My parents-in-law were reluctant to take me to the hospital. So I was forced to stay at home. I wanted to go to the hospital but it did not happen.”
This finding is consistent with previous research that has identified inadequate social support from family and spouses as a challenge in this context. Other research from India has illustrated a connection between women’s lack of decision-making autonomy and a higher likelihood of home birth. Poor knowledge and understanding about reproductive and maternal health among men is another critical barrier to facility-based delivery in India.
Eighteen women who gave birth at home reported that they were not able to get to a health facility to deliver because the vehicle did not arrive in time. One of the issues that arose in relation to transport was a woman’s lack of education about estimated delivery dates and average labor durations, which hinders women’s ability to prepare a birth plan.
Based on these findings, the authors conclude with recommendations for research and practice:
- Researchers should collect data on women’s preferences for delivery location when examining determinants of home birth.
- India’s Accredited Social Health Activists (ASHAs) could play an important role in educating women and families at the community level on birth preparedness to increase facility-based delivery.
Quality, equity and dignity should be a central focus in efforts to increase facility-based delivery to ensure that women in India and beyond receive timely, high quality, respectful care when they arrive at a health facility.
Explore other open access papers in the MHTF-PLOS Collection, “Neglected Populations: Decreasing Inequalities & Improving Measurement in Maternal Health.”
Learn about distance as a barrier to facility-based delivery.