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What if the baby doesn't survive? Health-care decision making for ill newborns in Ethiopia

Onarheim, KH; Sisay, MM; Gizaw, M; Moland, KM; Miljeteig, I; (2017) What if the baby doesn't survive? Health-care decision making for ill newborns in Ethiopia. Social Science & Medicine , 195 pp. 123-130. 10.1016/j.socscimed.2017.11.003. Green open access

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Abstract

Despite efforts to improve access to and quality of care for newborns, the first month after birth remains the most dangerous period of life. Given high neonatal mortality in low-income countries, saving newborn lives is a key priority for global and national health policy agendas. However, little is known about how these policies resonate with local understandings, experiences and household priorities. In this qualitative study we examined families' decision making and health-care-seeking in Butajira, Ethiopia. Data were collected through observation in hospital, in-depth interviews (41), and focus group discussions (7) with family members, health-care workers, and community members (October–November 2015). Transcripts and field notes were analyzed inductively using qualitative content analysis. Findings indicate that newborn health was not always the family's priority. Local perceptions of newborns as not yet useful members of the household alongside costly health-care services delayed decision making and care-seeking. While sickness was recognized as dangerous for the ill newborn, seeking health-care could be harmful for the economic survival of the family. In a resource-constrained setting, families' focused on productive assets in order to minimize long-term risks, and waited before seeking newborn health-care services. Until the baby had survived the first vulnerable weeks and months of life, the unknown newborn was not yet seen as a social person by the community. Personhood evolved progressively as the baby became a part of the family. A newborn death was surrounded by silence, and families received minimal support from traditional financial associations, iddirs. Decisions regarding health-care were contingent upon families' understandings of newborns and their resource-constrained circumstances. Improving newborn health involves recognizing why families choose to (not) seek health-care, and their actual opportunities and constraints in making such decisions. The everyday realities of vulnerable newborns must be at the center of global and national policy discussions and local implementation.

Type: Article
Title: What if the baby doesn't survive? Health-care decision making for ill newborns in Ethiopia
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.socscimed.2017.11.003
Publisher version: https://doi.org/10.1016/j.socscimed.2017.11.003
Language: English
Additional information: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
Keywords: Science & Technology, Social Sciences, Life Sciences & Biomedicine, Public, Environmental & Occupational Health, Social Sciences, Biomedical, Biomedical Social Sciences, Ethiopia, Newborn health, Health-care-seeking, Decision making, Personhood, Poverty, Qualitative research, MORTALITY, STILLBIRTHS, DISCOURSES, REGIONS, MOTHERS, INFANT, DEATH
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10070333
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