CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Increasing women’s access to quality skilled attendant has become a focus of global efforts to realize the right of every woman to the best possible health care during pregnancy and childbirth (UNFPA, 2010). Several authors have postulate that skilled attendants during labour, delivery and in the early postpartum period can prevent up to 75% or more of maternal deaths (Harvey, 2004 et al; Koblinsky, Heichelheim 1999).
Use of a skilled attendant (doctor, nurse, or midwife) at birth is one of the recognized indicators for measuring progress towards the Millennium Development Goal 5, that is, reduction of maternal mortality ratio. Improving women’s health is the fifth Millennium Development Goal as adopted by heads of states in September 2000. The agreed target is to reduce, by 2015, maternal mortality in developing countries by 75% of the 1990 figure. (MDG)
Despite various national and international efforts initiated to improve maternal health, more than half a million women worldwide die each year as a result of complications arising from pregnancy and childbirth the majority equally divided between Africa and Asia (Ronsmans, 2006). According to (Kowalewski, 2000) less than 1% of the pregnancy-related deaths occur in the more developed parts of the world, making maternal mortality the health indicator showing the greatest disparity between developing and developed countries. Despite the enhanced focus and awareness over the past decades, the situation in the poorest countries has not improved, and maternal mortality reduction is one of the explicit health millennium development goals.
Since the second half of the 20th century, the majority of births in the western world have taken place in hospital. Medicalisation of childbirth is a central feature in Western societies (Johanson, 2002). The majority of women living in high and middle-income countries have given birth in hospitals since the middle of the 20th century. However, there are regions where home birth is considered part of normal practice. The most cited case is The Netherlands where planned home birth is supported by the official healthcare system. Here, planned home birth is considered an appropriate choice for a woman of low risk and approximately 30% of all births take place at home (Hendrix 2009).
A significant proportion of mothers in developing countries still deliver at home unattended by skilled health workers (Montagu D, Yamey G, Visconti A, Harding A, Yoong J 2011). In diverse contexts, individual factors including maternal age, parity, education and marital status, household factors including family size, household wealth, and community factors including socioeconomic status, community health infrastructure, region, rural/urban residence, available health facilities, and distance to health facilities determine place of delivery and these factors interacting diverse ways in each context to determine place of delivery. In developing countries, pregnancy and childbirth are the leading causes of disability and death among women of reproductive age.
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