Factors Influencing Home Delivery and Related Challenges in Nyaruguru District, Rwanda: Qualitative Analysis

Objective: Sensitization to deliver at health facility aims in reducing maternal death and this is done worldwide and particularly in Rwanda. By 2015, 19% of women in Nyaruguru distrci delivered at home. This qualitative study aims to identify factors influencing home delivery and related challenges in Nyaruguru district. Methods: Purposing sampling was used to select 56 women who delivered at home. Additionally, 3 focus groups discussion was conducted; each focus group was composed by 7 members including 2 mothers, 2 community health workers, one nurse, in charge of social affairs at sector level and one community member. Guided interview was used to collect the views of mothers who delivered at home to understand the factors behind. Data was recorded and analyzed with in vivo. Verbal consent was obtained from all study participants and confidentiality was guaranteed. Results: Of the mothers who participated in the study, 25(44.6%) were aged above 30 years, 25(44.6%) attended only one ANC, 36(64.3%) had monthly family income between 20,000 to 50,000 RWf. The majority of respondents had community health insurance 46(82.1%). Regarding complications acquired during home delivery, 40(71.4%) had excessive vaginal bleeding, 6(10.7%) reported severe headaches/fever. 30(53.6%) reported that their child did not cry at birth. After getting complication 46(82.1%) reported to health facility to seek for advanced health care. The study identified a wide range of factors, including; traditional views, poverty, strong faith in traditional birth attendant, illiteracy and lack of knowledge regarding maternal health services, prevailing religious beliefs, geographical condition of same area of Nyaruguru that hinder the transport availability, and the fear of undergoing a caesarean delivery at health facilities. Conclusion: Individual, and healthcare system related factors influence home delivery. Healthcare programs can consider ensuring access to quality delivery services and provide transport facilitation for poor mothers from remote areas.