Womens Social Networks Use Of Skilled Birth Attendants And Experience Of Quality In Delivery Services In Jabi Tehinan Woreda Of The Amhara Region North West Ethiopia

High maternal mortality has remained an unmet public health challenge, particularly inrnthe developing world. Though maternal mortality ratio estimates for Ethiopia varyrnconsiderably due to methodological differences, most agree that maternal mortality isrnamong the highest in the world. Since most maternal deaths occur during labor, delivery,rnand the immediate postpartum period, skilled birth attendants (SBAs) at every deliveryrnhave been recommended to bring a marked reduction in maternal mortality. Nonetheless,rnthe majority of women in Ethiopia give birth at home assisted by untrained traditionalrnbirth attendants, relatives, or neighbors. This study investigated women’s socialrnnetworks, use of SBA, and the quality of facility delivery services experienced by womenrnin Jabi Tehinan Woreda of Amhara Region, North West Ethiopia. The study employedrnmixed methods research design. Quantitative data were collected retrospectively fromrn134 women who had uncomplicated births at health facilities and 140 women who hadrnuncomplicated births at home within a year preceding the survey. Eight women who hadrnuncomplicated births at a health facility and 11 women who had uncomplicated births atrnhome also participated in the qualitative study. Univariate and multivariate logisticrnregression were used to analyze quantitative data. The qualitative data were transcribedrnivrnand themes were developed for analyses. The results indicated that social networkrnvariables were significantly associated with SBAs use for delivery. Social networks betterrnexplain use of a facility for delivery services than women’s individual attributes. Womenrnembedded within homogeneous network members were 2.493(95% CI: 1.251-4.969)rntimes more likely to deliver at health facilities than women embedded within lessrnhomogeneous network members and the odds of women delivering at a health facilityrnincreased with increasing network size. Women embedded within high SBA endorsementrnnetwork member were 7.849 (95% CI: 3.906-15.773) times more likely to deliver atrnhealth facilities than women embedded within low SBA endorsement network members.rnSocial networks facilitate SBA utilization by serving as a reference for the behavior andrnsharing information about the available facility delivery services and the quality of thernservices. The odds of urban women to deliver in a health facility is 3.246 (95% CI: 1.362-rn7.734) times higher than rural women. The odds of women who had better knowledge ofrnobstetric complications to deliver in a health facility is 3.224 (95% CI: 1.564-6.647)rntimes higher than women who had limited knowledge about the complications. Nearlyrnhalf of the women (48%) who delivered at a health facility evaluated the quality ofrndelivery services as poor. Informants shared that attendants are not sympathetic forrnwomen’s pains and feelings and there is lack of privacy associated with the birthingrnposition at health facilities. These findings inform health professionals and otherrnstakeholders to understand the roles of women’s social networks and the quality ofrnfacility delivery services in designing interventions to increase the proportion of womenrnwho deliver at health facilities. The findings are also important for social work educationrnand designing social work interventions with pregnant women and their families

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