Challenges faced by skilled birth attendants in providing antenatal and intrapartum care in selected rural areas of Myanmar

ABSTRACT

Background: In Myanmar a large proportion of antenatal and intrapartum care in rural areasis provided by skilled birth attendants (SBAs), this study assessed the coverage by these healthworkers of all births, their adherence to service guidelines, and community opinion on the antenataland delivery care they give in two rural health centres in Pathein Township, Ayeyarwaddy Regionto identify the challenges and improve antenatal and intrapartum service delivery provided by theSBAs.Method: A structured questionnaire was used to interview 304 women who had infants under oneyear of age, and in-depth interviews were held with 12 SBAs and 10 community members.Results: Of the 304 pregnancies, 93% had received antenatal care (ANC); 97% of these werecovered by SBAs at an average 15 weeks’ gestation. The average frequency of ANC visits was 9.Rates of home and hospital deliveries were 84.5% and 13.8% respectively. Among home deliveries,use rate of SBA was 51.4%, while for postnatal care, 31.3% was given by unskilled providers(traditional birth attendants (TBAs) 17.5%, auxiliary midwives (AMWs),13.8%). Multivariate analysisshowed that interviewees aged 30 years and below (OR=0.468, P=0.046), with an education atprimary level and below that of husband (OR=0.391, P=0.007) or not residing in the village of therural/station health centre (OR=0.457, P=0.011) were significantly less likely to use SBAs. Thecategories of supervision, referral, and health education activities of SBAs were not in line withservice guidelines. The main reasons were lack of access and community acceptance of TBAs.Conclusion: Heavy workload, geographical location, transportation and financial concerns weremajor challenges for SBAs, along with community compliance and mutual coordination. Goodcommunication and service management skills were important to overcome these challenges.