Why some women who attend focused antenatal care fail to deliver in health facilities: a qualitative study of women’s perspectives from slums of Addis Ababa, Ethiopia

OBJECTIVE: The purpose of this study was to explore why some women who attend focused antenatal care (FANC) fail to deliver in health facilities from slums of Addis Ababa, Ethiopia. SETTING: Public health facilities (three health centres and one district hospital). STUDY DESIGN: A qualitative exploratory and descriptive research design was used. STUDY PARTICIPANTS: Study participants comprised women of reproductive age (18–49 years) living in slum areas of Addis Ababa, Ethiopia. We used 20 in-depth audio-recorded interviews. Data were analysed concurrently with data collection. Thematic analysis was done for the study. A multilevel life-course framework of facility-based delivery in low-income and middle-income countries developed by Bohren et al was used to frame the current study and link the findings of the study to the body of knowledge. RESULTS: From the analysis of in-depth interview data, four themes emerged, namely, perceived benefits of home delivery, knowledge deficit about health facility-based delivery, poor access to healthcare facilities and inadequate (demand side) resources. These themes were identified as rich and detailed accounts of the perspectives of facility-based and home delivery among attendees of FANC in Addis Ababa, Ethiopia. CONCLUSION: The findings of this qualitative study revealed that perceived benefits of home delivery, knowledge deficit about health facility-based delivery, poor access to healthcare facilities and inadequate (demand side) resources were related to low uptake of facility-based delivery services. Use of ANC visits to advise women about birth preparedness and complication readiness, the use of facility deliveries to reduce risks of home delivery to the mother and the newborn should be stressed.