Women living in poorer households of Dhaka, Bangladesh are unwilling to give birth at maternal healthcare facilities.
A new study, published in PLOS ONE, found that the women living in Dhaka slums were reluctant to use institutionalised maternal health care for fear of having to make undocumented payments, unfamiliar institutional processes, lack of social and family support, matters of honour and shame, a culture of silence and inadequate spousal communication on health issues.
Based on her PhD study undertaken at Flinders University, Associate Professor Sanzida Akhter of Dhaka University and her Flinders University supervisors, Associate Professors Gouranga Dasvarma and Udoy Saikia highlighted the reasons behind these women's reluctance to give birth in hospitals, despite government efforts to expand services across the country.
The authors of the paper say that their research highlights the importance of providing pregnant women with information to help them break free of fears about hospital childbirth, the hidden costs of healthcare and bridging cultural relations with providers.
"Even though low-cost health care facilities may be within their reach in terms of physical distance and affordable, these women and their families are unwilling to deliver their babies at such health facilities," say the authors.
"The financial, physical and social limitations of the women and those of their family members prevent them from seeking maternal health care at health facilities. They do not make any effort to overcome these barriers because they appear to be content with their age-old perception of pregnancy and childbirth as part of nature and not a special event worth giving any special attention to."
The contrast in the practice of maternal healthcare and childbirth between lower and upper socio-economic status women was also identified, with an example where 61% of the richer women opt for Caesarean Section deliveries compared to only 13% of the poorer women.
"This difference in maternal health care services and childbirth practised by the Bangladesh women clearly indicates that childbirth is influenced by a woman's socio-economic status and her cultural perception of childbirth."
The study also found poor behaviour by doctors and a lack of interpersonal communication with healthcare providers added to the pregnant women's reluctance to rely on traditional medical options.
"The women rightly expect to be treated respectfully and get information explained to them clearly but when their expectations aren't fulfilled, they rejected the thought of going there again. This is a situation, where 'interpersonal relations' go beyond simply only providing accurate information."