Let them talk about stillbirth: societal knowledge and attitude of the causes and risk factors of stillbirth in Kersa District, Ethiopia

Let them talk about stillbirth: societal knowledge and attitude of the causes and risk factors of stillbirth in Kersa District, Ethiopia

Simegn Tadesse (1), Eyoel Taye (1), Caroline Ackley (2,3), Anna Seale (3)

(1) Hararghe Health Research, Haramaya University, (2) Centre for Global Health Research, Brighton and Sussex Medical School, (3) London School of Hygiene & Tropical Medicine

Background:
Stillbirth rates in Ethiopia are as high as 30 per 1000 births. Hypertensive disorders of pregnancy, intrauterine growth restriction, infection and cord entanglement are causal factors. Despite these clinically derived causes of stillbirth communities have their own understandings of causes and risk factors. This study explores societal perceptions of what influences stillbirth in Kersa District, Ethiopia.

Methods:
We conducted a qualitative study from Oct-Dec 2018 with participants from Kersa District. The qualitative data collection methods used were 5 semi-structured interviews, 1 in-depth interview, and 3 focus group discussions (FGDs) involving health professionals, traditional healers, lead mothers in Ethiopia’s Women’s Health Development Army, mothers who had experienced stillbirth, men whose wives’ had, health extension workers, and adult males

Results:
Causes of stillbirth given by respondents were institutional factors related to poor care, lack of materials and medical error. Participants suggested that factors related to community level healthcare contribute to stillbirth; including malnutrition during pregnancy, traditional medicines, poor hygiene and sanitation, abortion, low family planning uptake, sexual intercourse in the third trimester, and domestic abuse. Finally, mystical causes like curses were also believed to increase the risk of stillbirth.

Conclusion:
Although participants were familiar with/could identify biomedical causes of stillbirth, their understanding differs from medical professionals’ in health centers and hospitals. Participants illuminated strong beliefs in traditional medicine and mythic causes and shed insight into related issues. There is a misalignment in understanding and communicating the causes and risks of stillbirth between the community and medical professionals. We suggest that better understanding the logic and language used will lead to more effective stillbirth interventions at the community level.

Ethics Statement:
Ethical approval for this study was obtained by the London School of Hygiene and Tropical Medicine, Haramaya University College of Medical Sciences, and the Ethiopian National Research Ethics Council. All names and identifying details have been changed to ensure the anonymity of research participants. All participants provided oral and written informed consent prior to participation. This research is funded by a Wellcome Trust Engagement grant.

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