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1.0. INTRODUCTION CHAPTER ONE 1.1. BACK GROUND INFORMATION All women should have access to basic maternity care during pregnancy and delivery. This includes antenatal care, clean and safe delivery as well as postpartum care for mothers and infants (WHO 1997). Every time a woman is pregnant which happens as estimated 200 million times every year around the world, a woman risks a sudden and unpredictable complication that could result in her death or injury, and the death or injury of her infant. At least 40% of all pregnant women will experience some type of complication during their pregnancies. For about 15% this complication will be potentially life threatening. Such complications can occur in pregnancy, during labour, delivery and postpartum period that require high quality obstetric care, (Koblinsky et al 1993). Attempts to predict these complications before they occur have not been successful since most complications are unexpected and the majority of women with poor pregnancy outcomes do not fall into any high risk categories (Graham 1997 and Ahmad 1998). Therefore pregnancy should be viewed as a special period during which all women should take particular care and seek treatment for certain signs and symptoms (WHO 1994). Basic maternity care comprises of quality antenatal care, clean and safe delivery whether the delivery takes place at home or in an institutional setting. One of the most important functions of antenatal care is to offer the woman advice information about the appropriate place of delivery given her own particular circumstances and health status. ANC is also an opportunity to inform women about the danger signs and symptoms for which assistance should be sought from a health care provider without delay (WHO 1994). 1
Globally Safe Mother Hood Initiative was launched in Nairobi 1987 to improve maternal health and cut the number of maternal deaths in half by year 2000. The initiative is a global effort that aims at reducing deaths and illness among women and infants also, especially in developing countries, (WHO and Sr. Kebe 1994). The initiative pledges the nations to implement Safe Motherhood Services, which is achieved by providing high quality maternal health services to all women. Among the services provided include care by skilled health personnel before, during and after delivery and emergency care for life threatening obstetric complication (WHO 1994). Throughout the world 75% of maternal mortality occurs during unassisted labour (Wachuku King S. 1994). A striking feature for most developing countries is that the proportion of women receiving Ante-natal care is distinctly higher than the proportion of women receiving delivery care in health units ( WHO 1997) World Health Organization (1997) estimates of coverage in maternity care reported that 65% of all pregnancies in Asia had at least once attended Antenatal care and 37% of deliveries took place in Health units. Likewise in Africa it has been estimated that 63% of pregnant women receive at least one Antenatal care visit and 36% of deliveries took place in Health units. Whereas 60% of deliveries in Western Africa and 56% in Northern Africa took place in Health units. (WHO 1997). Again a report by World Health Organization (1997) estimated that in East Africa approximately 66% of pregnant women who had at least one Antenatal care visit, only 32% of deliveries took place in Health units. It also stated that in Kenya only 44% of deliveries took place in Health units. In Tanzania despite of high antenatal attendances of pregnant women in various health facilities, maternal mortality rate is still high (529 per 100,000 live births) while infant mortality rate is still 99 per 1,000 births. Also, only 40% of pregnant women deliver in health facilities. In view of this, the MOH decided to strengthen the quality of 2
Page 1 and 2: PRIMARY HEALTH CARE INSTITUTE - IRI
Page 3 and 4: DEDICATION I dedicate this work to
Page 5 and 6: TABLE OF CONTENTS SUBJECT PAGE Decl
Page 7 and 8: LIST OF TABLES Table 1: Distributio
Page 9 and 10: ABREVIATIONS ANC - Ante-Natal Care
Page 11: ABSTRACT Health unit delivery is a
Page 15 and 16: and delivery in Health units for pr
Page 17 and 18: 2.0. LITRATURE REVIEW CHAPTER TWO S
Page 19 and 20: Several other studies have been don
Page 21 and 22: 3.0. RESEARCH METHODOLOGY 3.1. STUD
Page 23 and 24: 3.4. STUDY POPULATION The populatio
Page 25 and 26: The processed data was analyzed man
Page 27 and 28: 4.0. RESEARCH FINDINGS CHAPTER FOUR
Page 29 and 30: Table 5: Distribution of respondent
Page 31 and 32: Table 8: Distribution of Respondent
Page 33 and 34: The table above shows that women wh
Page 35 and 36: Table 14: Reasons given by mothers
Page 37 and 38: Introduction FOCUS GROUP DISCUSSION
Page 39 and 40: Focus group discussion with health
Page 41 and 42: Social Economic/Cultural factors ar
Page 43 and 44: HEALTH EDUCATION MODEL 5.3.THEORETI
Page 45 and 46: To reduce the complications that ap
Page 47 and 48: People will only perform a given be
Page 49 and 50: BIBLIOGRAPHY Ahmad Z. et al (1998).
Page 51 and 52: Ladfors L. et al (2001). A populati
Page 53 and 54: Walraven et al (2000) Maternal mort
Page 55 and 56: 8. How long does it take you to rea
Page 57 and 58: ANNEX 2 FOCUS GROUP DISCUSSION FOR
Page 59 and 60: ANNEX 2: QUESTIONS FOR FOCUS GROUP
Page 61: ANNEX 5: PERMISSION LETTER 47

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