Development of an Ethnographic Decision Tree Model for women's choice of birth attendance in Matlab, Bangladesh

Worldwide, 529, 999 women die each year from complications of pregnancy and childbirth, with 99% of deaths taking place in developing countries. The most effective strategy to reduce maternal mortality is for every woman to be assisted by a skilled birth attendant (SBA) who is supported or backed by emergency obstetric care. Success of this strategy, however, is dependent upon the availability and use of SBAs during childbirth. While lack of availability restricts use in many settings, data from recent studies suggest uptake is low even in settings where services are available. To understand the choice of birth attendants in such settings, an investigation into the decision-making strategy of women in Matlab, Bangladesh was conducted using Ethnographic Decision Tree Modeling. A hierarchical decision model was derived from 30 in-depth interviews with a purposive, heterogeneous sample of postpartum women age 18-49 who experienced a routine pregnancy and live birth in the 3 months prior to the study. The decision tree model will be presented along with plans to validate the model in a larger study using quantitative methods. Implications for birth preparedness and complication readiness interventions in Matlab will be discussed in the context of the global Safe Motherhood Initiative.