Eir wives are pregnant by asking us to talk to their wives about ANC and bringing them for labour to the purchase JNJ-54781532 health centre. If they know the Expected Delivery Date they wait for that time.” HEW1 explained that: “Men give good support, most husbands handle house affairs if the wife goes to ANC, men have to call the ambulance or invite people to help carry their wife to the road on a stretcher. Five years ago, some women took family planning in secret, now some women are even using IUCD.”PLOS ONE | DOI:10.1371/journal.pone.0150747 March 10,8 /Maternal Health Service Utilization and Acceptance in Adwa Woreda, EthiopiaFactors leading to skilled birth attendanceWe found that the facilitators to SBA included HEWs and WDGs who identified pregnant women and referred them to health posts for their first ANC visit and then subsequent visits to health centres. The WDGs assist HEWs by advocating the benefits of SBA to women and notifying the HEWs if a woman’s labour starts at home. HEWs organize for women to travel to health centres for delivery either before their EDD or if labour starts at home. Husbands play a crucial role in helping their wives Vesatolimod web attend ANC and SBA.Women’s Development GroupsWDG leaders and HEWs provide information about ANC and the need to give birth at health facilities. HEWs use stories during WDGs and other meetings at the kebele level to enable people to compare the past and the present. During the workshop and interviews, HEWs related some of these stories. For example, HEW15 first started working as a HEW around 10 years ago: “Back then, there was a lot of confusion about what to do and how to teach pregnant women. Almost no one attended ANC, no one had a health facility delivery and there was no road. There was so much resistance at the start and everyone said, `Why SART.S23506 should we go to a health facility? Everyone was born at home so there’s no need to go. It’s an additional expense.’ Since then, there have been many changes, sometimes it’s hard to keep up with what is expected of me. I’ve gained a lot in confidence if I compare the past to the present I can see changes in myself as well–overtime people have come to accept and trust me. There have been small changes that have made a big difference for women. For example, if a woman is very fearful about going to the health centre, I can go with her and stay with her but that is getting harder to do, as I’m just too busy and there are midwives in the ambulance now. But I talked to j.jebo.2013.04.005 the head of the health centre about allowing some traditional practices such as letting women put perfume on to burning incense (etan) during the labour and this has made a difference along with the picture of Mariam on the wall of the labour ward.” HEW9 related a story that the other HEWs decided to adopt to share with women in their kebeles: “Four years ago, before the ambulance service was introduced I was on my way to training in Mekelle when someone came and told me about a woman who was bleeding after home delivery and wanted my help. It was clear the others considered the situation as if the woman had already died. I tried to tell the family to take the woman to the hospital but they asked, `Why should we carry a dead woman?’ I had to insist that the woman be carried on a stretcher to the road but the rest of the family didn’t want to pay the extra costs of going to the hospital `if the woman was already dead.’ I asked some people to prepare a stretcher, and raised the mother’s legs up to increase.Eir wives are pregnant by asking us to talk to their wives about ANC and bringing them for labour to the health centre. If they know the Expected Delivery Date they wait for that time.” HEW1 explained that: “Men give good support, most husbands handle house affairs if the wife goes to ANC, men have to call the ambulance or invite people to help carry their wife to the road on a stretcher. Five years ago, some women took family planning in secret, now some women are even using IUCD.”PLOS ONE | DOI:10.1371/journal.pone.0150747 March 10,8 /Maternal Health Service Utilization and Acceptance in Adwa Woreda, EthiopiaFactors leading to skilled birth attendanceWe found that the facilitators to SBA included HEWs and WDGs who identified pregnant women and referred them to health posts for their first ANC visit and then subsequent visits to health centres. The WDGs assist HEWs by advocating the benefits of SBA to women and notifying the HEWs if a woman’s labour starts at home. HEWs organize for women to travel to health centres for delivery either before their EDD or if labour starts at home. Husbands play a crucial role in helping their wives attend ANC and SBA.Women’s Development GroupsWDG leaders and HEWs provide information about ANC and the need to give birth at health facilities. HEWs use stories during WDGs and other meetings at the kebele level to enable people to compare the past and the present. During the workshop and interviews, HEWs related some of these stories. For example, HEW15 first started working as a HEW around 10 years ago: “Back then, there was a lot of confusion about what to do and how to teach pregnant women. Almost no one attended ANC, no one had a health facility delivery and there was no road. There was so much resistance at the start and everyone said, `Why SART.S23506 should we go to a health facility? Everyone was born at home so there’s no need to go. It’s an additional expense.’ Since then, there have been many changes, sometimes it’s hard to keep up with what is expected of me. I’ve gained a lot in confidence if I compare the past to the present I can see changes in myself as well–overtime people have come to accept and trust me. There have been small changes that have made a big difference for women. For example, if a woman is very fearful about going to the health centre, I can go with her and stay with her but that is getting harder to do, as I’m just too busy and there are midwives in the ambulance now. But I talked to j.jebo.2013.04.005 the head of the health centre about allowing some traditional practices such as letting women put perfume on to burning incense (etan) during the labour and this has made a difference along with the picture of Mariam on the wall of the labour ward.” HEW9 related a story that the other HEWs decided to adopt to share with women in their kebeles: “Four years ago, before the ambulance service was introduced I was on my way to training in Mekelle when someone came and told me about a woman who was bleeding after home delivery and wanted my help. It was clear the others considered the situation as if the woman had already died. I tried to tell the family to take the woman to the hospital but they asked, `Why should we carry a dead woman?’ I had to insist that the woman be carried on a stretcher to the road but the rest of the family didn’t want to pay the extra costs of going to the hospital `if the woman was already dead.’ I asked some people to prepare a stretcher, and raised the mother’s legs up to increase.
