Maternity services and TBAs in Addis Ababa: biosocial factors related to birth place and outcome of pregnancy

Abstract

The use of maternity services in Addis Ababa was assessed through a household probability sample survey in 1983. For 9315 women, 9954 pregnancies were reported over a two-year period from September 1981. This study analyses the antenatal care and deliveries of 8724 women. Antenatal care coverage was 70%; 40% of births took place in hospital; 16% in MCH clinics; 44% at home of which 19% were attended by traditional birth attendants (TBAs). Services were under-utilized by women of low socio-economic status: 1:5 women giving birth at home had no antenatal care and 50% of these delivered unaided. Maternal mor tality was threefold among women who delivered at home without a TBA (410.7 per 100 000 live births) compared to those attended by TBAs. The stillbirth/neonatal death ratio of home deliveries conducted by TBAs was 0.5:1. Prospects and options for extension of care for disadvantaged pregnant women are discussed.