Post on 20-Dec-2015
Making Facilities Birth-Friendly in Timor-Leste
Susan Thompson, MPH• Health Alliance International • University of Washington, Seattle, WA
2005 Baseline Assessment
• Common understanding that a MW should only be called if there is a problem
• Strong preference for home delivery
• Husbands/family play an active role in birth preparation & delivery
• Traditional birthing practices important
Negative Associations with Facility-based Births
• Lack of privacy
• No hot water
• No traditional wooden bed
• No rope hanging from ceiling
• Family members not always welcome
Concept Development: Birth-Friendly Facilities
Create a comfortable space that respects desired traditional practices where women and families
can delivery their babies
• Involvement with key stakeholders Partnership with the MOH Strong community socialization process Connected health staff with communities
• Local investment Rebuilt a destroyed building Used local labor and materials
• Complete integration into MOH system
Birth-Friendly Facility: Program Objectives
• Increase # of women delivering with SBA
• Increase knowledge of benefits of SBA
• Improve linkages between community & health facility
• Improve health staff understanding of desired traditional birthing practices
Formative Evaluation
Methods• Qualitative
–Semi-structured interviews–Key informant interviews–Focus group discussions–Observations
• Quantitative –Analysis of utilization trends
Evaluation Questions
• Who is the BFF serving?• Are BFF users & providers
satisfied?• What factors influence
use of the BFF?• What are the barriers to
utilization?• Has knowledge changed
in the community?• Is SBA increasing?
Respondent Demographics
BFF UsersBFF Non-
users
Mean age 26.4 years 25.9 years
No formal education 33% 56%
Primary school education
27% 22%
Mean # of children 3.13 4.22
Mean # of pregnancies 3.73 4.89
Findings
Non Users UsersNone had experience of a facility-based birth
50% of women had a previous facility-based birth
Little experience of SBA Had more experience with SBA in the past
Lack of family support Family supported decision
Labor progressed quickly and/or at night
What influences the use of BFF?
• Knowing midwife is available
• Perception of safety/fear of complications
• BFF is “complete” with MW, medicines, equipment
• Traditional practices possible
• Family support• Respect• Families welcomed
“I thought the BFF would be the same as the clinic, but when I saw inside and realized that there was a wooden bed and
rope, I was really happy.”
Barriers to Using the BFF
• Lack of transportation• Fear• Unaware of benefit of
SBA• No birth plan
“I thought about using the BFF, but I went into labor at night, and I was
scared to walk to the clinic…I worried that I would deliver my
baby while traveling to the facility.”
Brainstorming
We would like you to think about how you would approach expanding the use of the Birth-Friendly Facilities.
What programmatic adaptations could be implemented at the community or facility level?
What did we learn?
• Achieving change of deeply entrenched practices is a process which requires time
• Engaging communities throughout the entire process of a community-based program is the key to success
• Formative evaluation of the implementation phase can identify adaptation needs at an early stage
What did we learn? (cont)
• Birth planning needs more focused promotion
• Need outreach health promotion to remote areas with less access to health system
• MOH ownership key to sustainability• Work with MOH & communities to expand
the use of the BFF space