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

Maternal and newborn health is a serious public health problem in sub-Saharan Africa with inequities in access to competent birth attendance persisting, especially in rural areas. Introduction Birth Preparedness and Complication Readiness (BPCR) is extensively promoted but there is little qualitative research on how the components of BPCR are negotiated at the time of labour within home and community contexts. This study evaluated factors influencing the choice of delivery site among breastfeeding women in Petauke and Lusangazi Districts of Eastern Zambia. A qualitative interpretative phenomenological design was used. Data was collected through four focus group talks (n=20) and 17 semi-structured interviews (n=17). The data were recorded as audio files, transcribed verbatim, and analyzed using reflexive thematic analysis. Results showed that delivery location decisions are determined by an interaction of structural, socio-cultural and individual factors. Barriers to facility delivery included distance, lack of mobility, poor road conditions, financial constraints and insufficient spouse assistance. Family authority and cultural norms were other factors in decision-making. Birth readiness, antenatal care attendance, perceived safety, pleasant previous experiences and community sensitization through Safe Motherhood Action Groups promoted facility delivery. This study adds new knowledge by showing that birth readiness is not an individual action, but rather a socially negotiated process that is influenced by family dynamics and community norms. Improving facility-based delivery in rural Zambia will require integrated initiatives that address mobility challenges, improve antenatal counselling, encourage male involvement and employ community-based health education