Submission ID 130219
| Issue/Objective | Respectful maternity care remains a critical priority in Ethiopia, where institutional births have increased but women's satisfaction continues to lag due to gaps in supportive care practices. Continuous support from a chosen birth companion-endorsed by the World Health Organization as a key intervention for improving maternal and newborn outcomes-has not been widely implemented across Ethiopian health facilities. Maternity care providers play a pivotal role in facilitating or hindering companion presence, yet their perceptions and the factors influencing adoption of this practice remain underexplored in the Ethiopian context. This study examined maternity care providers' perceptions of birth companionship and identified determinants influencing its adoption in public health facilities of Illu Aba Bor and Buno Bedelle zones, Southwest Ethiopia. The findings aim to inform interventions that align facility practices with global respectful maternity care standards, directly contributing to the conference sub-theme of "Equity in action: Health systems, resilient systems and communities." |
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| Methodology/Approach | A mixed-methods, institution-based cross-sectional study was conducted from March 1 to May 1, 2024, across public health facilities in Illu Aba Bor and Buno Bedelle zones, Southwest Ethiopia. Quantitative data were collected from 481 maternity care providers selected through simple random sampling using a pretested, structured questionnaire. Data were analyzed using multivariable logistic regression to identify determinants of positive perceptions toward birth companionship. Qualitative data were gathered through 11 key informant interviews with facility administrators, senior midwives, and quality improvement officers. Interview transcripts were analyzed thematically to explore barriers, facilitators, and contextual factors influencing companion presence during childbirth. The mixed-methods design allowed for triangulation of findings, providing both breadth of generalizability and depth of contextual understanding. |
| Results | Overall, 59% of providers demonstrated positive perceptions toward birth companionship. Key determinants significantly associated with positive perceptions included having received relevant training on birth companionship (AOR = 3.51; 95% CI: 2.10-5.87), perceiving companionship as important for maternal outcomes (AOR = 3.77; 95% CI: 2.25-6.31), good awareness of existing guidelines (AOR = 2.25; 95% CI: 1.42-3.57), and having more than ten years of clinical experience (AOR = 2.11; 95% CI: 1.28-3.48). Qualitative findings revealed that providers recognized benefits of birth companionship, including improved maternal satisfaction, reduced anxiety, and enhanced emotional support during labor. However, significant barriers were identified, including overcrowding in labor wards, limited physical infrastructure to accommodate companions, lack of clear facility-level protocols, and concerns regarding privacy and confidentiality. These barriers collectively constrained providers' ability to facilitate companion presence despite their favorable attitudes in some cases. |
| Discussion/Conclusion | The proportion of maternity care providers with good perceptions toward birth companionship in this study was 59.0%, which is lower than the 82.4% reported in a previous Ethiopian study (Doba et al., 2023) and considerably lower than findings from India where 78% of providers held positive perceptions (Sarwal et al., 2023). This discrepancy may reflect variations in healthcare delivery systems, training availability, and implementation of respectful maternity care initiatives across settings. The finding is concerning given that the World Health Organization strongly recommends continuous companionship during labor as a core intervention for improving maternal and newborn outcomes (WHO, 2018). When providers lack positive perceptions, implementation of companion presence becomes inconsistent, depriving women of documented benefits including shorter labor duration, reduced need for analgesia, and enhanced maternal satisfaction (Bohren et al., 2023; Kabakian-Khasholian and Portela, 2017). Significant determinants of positive perceptions included having received relevant training (AOR = 3.51), which aligns with evidence that training enhances provider knowledge and attitudes regarding supportive care (Hulsbergen et al., 2023). Providers who recognized the importance of companion presence were nearly four times more likely to hold positive perceptions (AOR = 3.77), reflecting that understanding the benefits-such as emotional support, improved maternal confidence, and reduced staff workload-shapes provider attitudes (Getahun, Ukke and Alemu, 2020). Good awareness of birth companionship (AOR = 2.25) and more than ten years of clinical experience (AOR = 2.11) were also significant predictors. Qualitative findings reinforced these results, with providers articulating numerous benefits while also identifying substantial barriers, including overcrowding (71.9%), lack of privacy (67.7%), and confidentiality concerns (62.2%). Addressing these gaps requires a multi-pronged approach. The strong association between training and positive perceptions underscores the need for zonal health departments to establish and strengthen systematic in-service training programs on birth companionship (WHO, 2020). Additionally, facility-level interventions-including creating physical partitions, developing clear companion guidelines, and investing in infrastructure to reduce overcrowding-are essential to overcome implementation barriers (Jolivet et al., 2021; Chaote et al., 2021). By addressing both provider-level and system-level determinants, Ethiopian health facilities can harmonize their practices with WHO recommendations and advance respectful maternity care, ensuring all women have access to supportive, dignified childbirth experiences. |
| Presenters and Affiliations | Bikila Jiregna Mattu University Getu Amsalu Mattu University Bikila Jiregna Mattu University Wubshet Gizmu Mattu university |
