Determinants of Delivery Site Selection Among Breastfeeding Women in Petauke and Lusangazi Districts, Eastern Province, Zambia

Abstract

Although maternal and newborn mortality have shown improvements in the last decade, maternal and newborn health remain serious public health problems in sub-Saharan Africa. This is especially true in rural communities where inequities in access to professional birth attendance exist. While there is growing promotion of Birth Preparedness and Complication Readiness (BPCR), home deliveries are still common in many rural communities in Zambia. The study evaluated the factors influencing delivery site choice among breastfeeding mothers in Petauke and Lusangazi Districts of Eastern Province, Zambia, with a particular focus on the function of birth readiness. Qualitative interpretative phenomenology was utilized to study women’s lived experience of decision-making regarding pregnancy. Data were obtained using four Focus Group Discussions (FGDs) with women who delivered at home (n=20, five in each group) and 17 Semi-Structured Interviews (SSIs) with women who delivered at healthcare facilities. Bringing the total to 37 participants. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using an Interpretive Phenomenological Analysis (IPA) design operationalized through reflexive theme analysis, following Braun and Clarke’s six-step technique. The findings revealed that the selection of delivery sites was shaped by a complex interplay of structural, socio-cultural, economic, and individual factors. Distance to health facilities, lack of mobility, poor road infrastructure, budgetary constraints, cultural traditions, and restricted decision-making power among women were the key hurdles to institutional delivery. Institutional delivery was facilitated by birth preparedness, antenatal care attendance, spouse support, community knowledge, fear of problems, and past favorable experiences with facility-based care. The study showed that preparing for childbirth is not just a personal duty but also a socially negotiated process influenced by household support networks, socio-economic factors, and community norms. These findings emphasize the need for integrated maternal health programs to improve transportation infrastructure, boost antenatal counseling, foster male involvement, and extend community-based maternal health education activities.