Barriers and Facilitators Influencing Facility-Based Delivery in Rural Haiti: A Mixed Method Study With a Convergent Design

Abstract

The maternal mortality rate in Haiti is high, at around 380 maternal deaths for 100,000 livebirths. Sixty-three percent of Haitian women continue to give birth at home,1 placing them at higher risk for complications and maternal mortality. The strategy of facility-based delivery in resource poor settings should to centered around the intrapartum care of pregnant women at a facility.2 This strategy needs to be accompanied by a network of facilities that can provide basic deliveries with skilled birthed attendants, adequate supplies, drugs, and a referral system for more complicated deliveries.3 This mixed method study used a convergent design to identify barriers and facilitators to facility-based birth in rural Haiti. Quantitative data were collected to describe the study population and multiple regression analysis was done to assess barriers to facility-based delivery. Variables analyzed were places of residence, distances, levels of poverty, miscarriages, stillbirths, livebirths, and numbers of living children. Qualitative data provided a deeper understanding of the lived experience perceptions, beliefs, and desires in navigating the system. We found that several factors including distance, socioeconomic condition, and rituals influence the place of delivery. Many women concerned about complications and the safety of home-based delivery want to give birth at a facility. The pregnant women living in rural Haiti, particularly in Mirebalais, want to give birth at a hospital. These findings may help decision makers choose policies that increase facility-based deliveries in order to decrease maternal mortality in Haiti.