Provision of individualised obstetric risk advice to increase health facility usage by women at risk of a complicated delivery: A cohort study of women in the rural highlands of West Ethiopia

Abstract

Objective To determine whether the provision of individualised obstetric risk advice would increase health facility usage in women at life-threatening risk of a complicated delivery in Ethiopia, where maternal mortality has remained high and static for a decade and where, although the government has increased the number of health facilities, 90% of women deliver their babies at home. Design A prospective cohort study. Setting Rural Ethiopian highlands. Population A total of 294 pregnant women at 32 weeks or more of gestation. Methods Before being provided with individualised risk advice, women were asked about their birth plans, and in particular, their planned delivery place. Those identified as being at risk of a complicated delivery were followed up to find out whether they altered their birth plans. Main outcome measure A change in birthplace. Results Women identified as being at high risk of a complicated delivery significantly changed their plans (P < 0.01), with 34 (89%) women delivering in hospital. Women with a medium risk did not significantly change their birth plans (P = 0.082), with 35 (36%) delivering at home. Women with a high parity were less likely to change their birth plans compared with primigravid women (odds ratio 0.53; 95% confidence interval 0.34-0.83) and high-risk women were more likely to change their plans compared with medium-risk women (odds ratio 6.2; 95% confidence interval 1.8-21.6). Conclusions Providing simple, individualised advice about the risks of a complicated delivery leads to high-risk women delivering in hospital. Embedding this into the current antenatal care system in Ethiopia could significantly decrease maternal mortality. © 2013 RCOG.