Cultural birth preparedness practices and associated factors among mothers in rural areas of Central Ethiopia: A concurrent mixed-methods design

Abstract

Background: Evidence indicates that birth preparedness and complication readiness practice remain a significant problem and is not well practiced in many low-income countries, including those in East Africa. Although birth preparedness and complication readiness is practiced at low levels in most developing settings, existing literature suggests that cultural birth preparedness practices in Central Ethiopia remain underexplored, with limited empirical evidence documenting their nature and influence on maternal health outcomes. Therefore, this study aimed to assess cultural birth preparedness practices and associated factors in Central Ethiopia. Methods: A community-based cross-sectional study with a mixed approach was conducted from February 15 to March 16, 2023. A total of 634 mothers who gave birth within the last 6 weeks were selected by a systematic random sampling technique. Quantitative data were collected via pretested questionnaires and analyzed using bivariate and multivariable logistic regression. Variables with a p < 0.05 were considered statistically significant. For the qualitative data, five focus group discussions and 35 in-depth interviews were conducted to explore community cultural birth preparedness practices. Both inductive and deductive thematic analysis were employed in analyzing the qualitative data. Results: A total of 627 rural mothers from Gurage Zone were enrolled, with a response rate of 98.9%. The overall cultural birth preparedness was 84.2% (95% confidence interval: 79.8–89.3). A family size of five or more (adjusted odds ratio = 2.5; 95% confidence interval: 1.81–8.63), a birth interval of 2 or more years (adjusted odds ratio = 3.06; 95% confidence interval: 2.21–9.37), and multiparous (adjusted odds ratio = 2.32; 95% confidence interval: 1.06–10.75) were factors associated with cultural birth preparedness practices. In qualitative findings, material birth preparation, peer support group (networks), financial preparedness, engagement with traditional birth attendants, and spiritual practices were factors influencing the cultural birth preparedness practices. Conclusion: In this study, 84.2% of mothers practiced cultural birth preparedness. Family size, birth interval, and multiparity were associated with cultural birth preparedness practices. In addition, material, financial, peer, and spiritual supports further influenced these practices. These findings indicated that incorporating culturally acceptable birth-preparedness components into maternal health programs can strengthen community engagement, improve birth readiness, and reduce maternal complications.