assessment on the danger associate with home delivery of child bearing age



The vast majority of women who deliver outside the health facilities give birth at home, where risks of mortality women in the world have access to such skilled care in developing countries, however, still most women deliver at home (WHO, 2013; Folashade et al., 2013). Worldwide, an estimated 529,000 maternal and nearly 4 million neonatal deaths (during the first 4 weeks of life) occur annually, 75% of neonatal death is in the first week of life. Approximately, 99% of these deaths are in low and middle income countries, where 43% of births are attended by TBAs, the proportion generally being higher in rural areas (WHO, 2013). These home deliveries conducted by TBAs may be responsible for an increased risk of maternal and perinatal mortality as the TBAs have low educational status and sometimes were not trained in preventing or recognizing complications and promptly referring the patient to an appropriate facility for emergency obstetric care (WHO, 2013; Folashade et al., 2013). In addition, nearly 4 million stillbirths occur annually, and most of them are close to the time of delivery (WHO, UNFPA, WB, 2009). Of the neonatal deaths, nearly 50% occur among children delivered at home. Perinatal mortality (stillbirths and neonatal deaths) is often related to intrapartum complications, and is, thus, higher in countries where highest deliveries are conducted at home environment. It has been estimated that decreasing the proportion of deliveries conducted at home reduces perinatal and maternal deaths by nearly half (WHO, 2013; Folashade et al., 2013, WHO et al., 2009; Sychareun et al., 2009). The five major pregnancyrelated complications leading to maternal mortality globally are postpartum hemorrhage (25%), puerperal infections (15%), unsafe abortion (13%), hypertensive disorders of pregnancy (12%) and obstructed labor (8%). About 35% of women in developing countries receive no antenatal care during pregnancy; and 70% receive no postpartum care. In these countries, home deliveries are over 60% taking place largely in rural areas with unskilled attendants (WHO et al., 2008; Mwanakulya et al., 2008). According to study in Malaysia (2009), more than 90% of births occur at home with unhygienic conditions and without assistance of trained birth personnel (Sychareun et al., 2009). In Ethiopia, in 2000/2001, 871 maternal mortality per 100,000 were recorded as the highest rates of maternal mortality in Africa, and then reduced to 676 maternal mortality per 100,000 births in 2010/2011. Ethiopia was one of the six countries which accounted for more than 50% of all maternal deaths in 2012. The proportion of deaths due to postpartum hemorrhage (PPH) that occurred is most likely due to the fact that over 90% of births take place at home, and women with PPH may not arrive at a health facility on time (EDHS,2011). In Ethiopia, the proportion of births attended by skilled personnel in health institution has increased in a very slow fashion from 2005 to 2011. The majority of Ethiopian women give birth at home without skilled attendants. Further, as reported in 2011, Ethiopia Demographic and Health Survey (EDHS), the 90% of births at home take place in unhygienic conditions and associated with adverse infant and maternal outcomes. There is no significant difference in proportions of home delivery between EDHS in 2005 and 2011 (Sibley et al., 2009; Central Statistical Agency [Ethiopia] and ICF International, 2012; Mwanakulya, 2008; Ethiopia MDG Report, 2013; Pakistan Demographic and Health Survey, 2006-07). The rate of home delivery in Ethiopia is in the highest bound by sub-Saharan Africa standard (Central Statistical Agency [Ethiopia], ICF International, 2012; Pakistan Demographic and Health Survey, 2006-07). According to health and health related indicators’ report, Skilled Birth Attendant (SBA) of Ethiopia was 23% (EFMOH, 2013) and the achievement of Southern Nation Nationalities peoples Region (SNNPR) was 20.6% (EFMOH, Health and Health related indicators, Oct. 2014). In Ethiopia, according to the latest estimate of United Nations, the MMR has declined from 676/100,000 live births in 2011 to 420/100,000 live births in 2013 (UNDP, 2014).

Therefore, the purpose of this study was on  assessment on the danger associate with home delivery of child bearing age. This study will be helpful for the relevant stakeholders in the planning and implementation of intervention activities to improve the delivery service utilization through significant reduction of giving birth at home.