Exploring Religious leaders’ experiences and challenges on Childbirth at Health Institutions. A qualitative study

Background Childbirth at health institutions is critical to preventing major maternal and newborn deaths. In low and middle-income countries, many women still give childbirth without skilled assistance. Religious leaders may play a crucial role to promote childbirth at health institutions. So, this study aims to explore religious leaders’ experiences and challenges in childbirth preparedness and childbirth at health institutions. Methods After ethical approval was secured from Jimma University, Ethiopia, and the University of Ottawa, Health Sciences and Research Ethics Boards, Canada an exploratory study was conducted from Nov 2016 to February 2017. Data were collected from 24 religious leaders. Atlas ti software 7.5.18 package was used to assist the analysis. Identified themes and categories were interpreted and discussed with related studies. Results Lower awareness level, family needs for traditional birth rituals at home, lack of access to roads and transportation, lack of medical supplies, poor quality of health care provision and lack of respect for laboring mothers were the challenges raised by study participants. There was a traditional way of childbirth preparedness but is not matched due to economic status and level of awareness. The majority are inclined to say that destiny of maternal health outcome is determined by God/Allah’s will though not contradicting childbirth at a health institution. Conclusion A comprehensive approach to include religious leaders to increase awareness and positive beliefs towards childbirth at health institutions should be considered. Health institution factors such as respect for laboring mothers, medical supplies, and equipment should be improved. Access to roads or transportation also needs to be communicated to responsible bodies and community leaders to improve transportation problems. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was secured from Jimma University, Ethiopia, and the University of Ottawa, Health Sciences and Research Ethics Boards, Canada. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data cannot be shared publicly because of ethical consent issues. However, data are available from the principal investigator or corresponding author by emailing directly to him/her. * AIDS : Acquired Immuno-deficiency syndrome; ANC : antenatal care; CB : Childbirth; C BP : Childbirth Preparedness; CBHI : Childbirth at Health Institution; EDD : estimated date of delivery; FGD : focus group discussion; FMOH : Federal Ministry of Health; HEW : Health Extension Worker; HC : Health Centre; HI : Health institution; HIV : Human immuno-deficiency virus; HP : Health Post; IDI : in depth interview; IEC : information, education and communication; JZHO : Jimma Zone Health Office; JU : Jimma University; MDA : Male Development Army; MNCH : Maternal, newborn and child health; MWH : Maternity waiting Home; PHCU : Primary Health Care Unit; PNC : postnatal care; RL : religious leader; CBHI : CHILDBIRTH AT HEALTH INSTITUTION; SBA : Skilled Birth Attendance; UoO : University of Ottawa; WDA : Women Development Army ZHO : Zone Health Office