Qualitative descriptive study of decision-making factors that influence women’s and men’s choices towards place of birth in rural Western Highlands of Papua New Guinea

Author: Paula Zebedee Aines

Zebedee Aines, Paula , 2019 Qualitative descriptive study of decision-making factors that influence women’s and men’s choices towards place of birth in rural Western Highlands of Papua New Guinea , Flinders University, College of Nursing and Health Sciences

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Despite the availability of health facilities in the rural Western Highlands Province of Papua New Guinea (PNG), women seek out health facilities during pregnancy, but not to give birth. Studies have found that in the Western Highlands, only 23% of women were assisted by skilled birth attendants at a health facility, in comparison to the already low national figure of 43% (National Department of Health, 2013). Molar and Kirby (2013) identified in their study that the remaining births took place in remote or rural homes or in the villages assisted by an untrained person or relatives (Mola & Kirby, 2013). PNG has one of the highest maternal mortality rates in the world and the highest among other Pacific nations, with an estimated rate of 500 deaths per 100,000 live births (Mola & Kirby, 2013). Despite reports of the low number of supervised births, there is only limited research that has focused on maternity care in PNG. The few studies conducted primarily focused on antenatal care, rather than intrapartum and postnatal care, which are significant components of maternal health, as most obstetric complications and maternal deaths occur during and immediately after birth (Mola & Kirby, 2013). In addition, these studies have focused on the factors that create barriers to accessing health facilities. However, there are no existing published studies that have explored the decision-making factors involved in choosing place for intrapartum care.

To bridge this gap in the literature, this study aimed to explore the experiences of women and men in their decision-making regarding place of birth in the rural Western Highlands of PNG. The objectives of this research project are to investigate the factors that influence women’s and men’s decisions in choosing place of birth, and to examine the needs and expectations of women and men in relation to the birthing context. A qualitative descriptive approach was used. Semi-structured in-depth interviews were conducted with 20 participants (16 women and 4 men) living in the rural Western Highlands of PNG who had recent birthing experiences or were currently pregnant, or who had partners who were currently pregnant. A thematic analysis of the data was undertaken, from which three themes emerged, accessibility and availability, socio-cultural influences, and maternity care experiences.

The study revealed that the majority of the participants wanted a health facility birth; however, due to accessibility and availability factors, they reluctantly decided not to, or circumstances required them to give birth in their village. Previous birth experiences in both health facilities and the village environment were a significant factor influencing the participant’s decision for place of birth. Accessibility factors identified included finance, transport, partner or family support, geographical challenges, socio-cultural influences, and birth preparedness. Availability factors included medical resources and health services. Previous maternity experiences related to quality of care, and perceptions of medical intervention, care providers’ attitudes, and the birthing environment. These findings were discussed using a revised primary healthcare conceptual framework by Levesque, Harris and Russell (2013).

The findings provide an understanding that despite women’s initial decisions to give birth in a health facility, factors relating to accessibility, availability, and previous maternity experiences had a negative impact on their decisions, thus resulting in village births that were not of their choice. Therefore, this study recommends a collaborative approach by clinicians, health managers, policymakers and service providers to address these identified factors and to implement change to increase health facility births in rural Western Highlands of PNG. Further research from the perspective of health workers is recommended, in addition to research on antenatal care in this study setting, and patriarchal decision-making control.

Keywords: Papua New Guinea, place of birth, decision-making towards place of birth, rural child birth, health facility birth, birthing experiences, pregnancy

Subject: Midwifery thesis

Thesis type: Masters
Completed: 2019
School: College of Nursing and Health Sciences
Supervisor: Ms Kristen Graham