Preference for home births in rural Bangladesh: A qualitative exploratory study

Despite the renewed commitment to increase the rate of health facility-based delivery, more than half of all deliveries still take place at home in rural Bangladesh with the support of traditional birth attendants (TBAs), which leads to high maternal mortality as well as poor maternal health and pregnancy outcomes. The aim of this study was to identify the reasons for preferring home delivery among rural communities in Bangladesh. The data were gathered through three Focus Group Discussions (FGDs) among three different groups of stakeholders, viz., nine women, seven men, and nine health service providers. Thus, 25 individuals participated in this study. FGDs were conducted in a rural sub-district of Bangladesh. Thematic analysis was performed. The findings revealed a high preference for home delivery attended by TBAs among rural communities, as it was convenient, easily affordable, comfortable, and suitable for maintaining social rituals during labor and after delivery. Cultural practices and belief systems are the most frequently cited reasons for preferring home delivery with the help of a TBA. Other major reasons for choosing home delivery included financial constraints, inadequate knowledge about services offered by the health care facilities and lack of awareness about service delivery points, poor road conditions, and lack of transportation to reach the nearest health facility. Poor quality of services at the health care facility, perceived fear of undergoing cesarean delivery at the health care facility, and lack of lady doctors at the health care facilities also had a significant impact on the choice of home delivery. To further increase health facility-based delivery in Bangladesh, there is an urgent need to design a comprehensive maternal health program with culturally appropriate interventions, duly addressing the reasons for preferring home delivery that have been identified in this study. In the long run, promoting women’s education, reducing poverty, and improving the quality of all services at the health care facilities, particularly in the rural hinterlands of Bangladesh, would improve maternal health and pregnancy outcomes in the communities and reduce high maternal mortality.