Exploring Reasons and Perspectives Behind Decisions to Forego Hospital Births Among Remote Rural Populations in Bokeo Province, Lao PDR

Krissana Kapheak, Nonthaphat Theerawasttanasiri, Potchara Khumphoo, Chansy Chayaseng, Phouangphet Bounmaseng, Ninrat Pangsri, Jukkrit Wungrath
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Abstract

Maternal mortality remains high among marginalized rural populations in Laos. Remote mountain villages in Bokeo Province typify persistent health access divides facing minor subgroups amidst infrastructure gaps and scattered habitation. This study explores complex drivers behind shunning hospital births using focused rural ethnography. Between October and November 2023, this qualitative study interviewed 40 participants including pregnant women, postpartum women, and their relatives across 5 villages in Bokeo Province regarding barriers to hospital births. Open-ended discussions aimed to elucidate motivations and barriers embedded in their decision to avoid formal delivery care, despite mortality awareness. Transcriptions from Lao were translated to Thai, maintaining cultural nuances. Thematic analysis identified patterns in women’s attitudes and barriers to hospital childbirth. A collaborative coding process revealed constraints on access, affordability, and autonomy, explaining why vulnerable groups often forego hospital births despite risks. The result founded that prohibitive transportation deficiencies including impassable roads, exorbitant driver fees and unreliable conveyance options were primary obstacles. Prohibitive direct and indirect costs compounded struggles for impoverished families. Restrictive traditions persisted among certain ethnicities. Discrimination fears and hospital foreignness also provoked wariness among a minority. Multidimensional geographical, financial and sociocultural barriers intersect to obstruct rural groups from accessible emergency obstetric care in Laos. Infrastructural strengthening, financial protection and public education can relieve these pronounced constraints denying the marginalized realization of maternal health rights.
探讨老挝博胶省偏远农村人口决定放弃住院分娩的原因和观点
老挝边缘化农村人口的孕产妇死亡率居高不下。博胶省的偏远山村是一个典型的例子,在基础设施不足和居住分散的情况下,小群体在获得医疗服务方面面临着持续的鸿沟。本研究通过集中的农村人种学研究,探讨了避开医院分娩背后的复杂驱动因素。2023 年 10 月至 11 月期间,这项定性研究在博胶省的 5 个村庄采访了 40 名参与者,其中包括孕妇、产后妇女及其亲属,了解她们在医院分娩时遇到的障碍。开放式讨论旨在阐明她们决定避免正规分娩护理的动机和障碍,尽管她们已经意识到死亡率问题。在保留文化细微差别的前提下,将老挝语记录翻译成泰语。专题分析确定了妇女对住院分娩的态度和障碍的模式。合作编码过程揭示了在获取、可负担性和自主性方面的限制因素,解释了弱势群体为何经常不顾风险而放弃住院分娩。研究结果表明,交通不便是主要障碍,包括道路不通、司机收费过高和运输工具不可靠。高昂的直接和间接费用加剧了贫困家庭的困境。在某些种族中,限制性传统依然存在。对歧视的恐惧和医院的陌生感也引起了少数人的戒心。地理、财政和社会文化等多方面的障碍交织在一起,阻碍了老挝农村群体获得紧急产科护理。加强基础设施、财政保护和公共教育可以缓解这些明显的制约因素,使被边缘化的群体能够实现孕产妇保健权利。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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