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Author Notes:

Correspondence to Dr. Nancy K. Beam: docbeamphd@gmail.com

Contributors: Nancy K Beam, Gezahegn Bekele Dadi, Sally H Rankin, Sandra Weiss, Bruce Cooper and Lisa M Thompson participated in the conception of the study.

NKB and GBD participated in the acquisition of the data.

NKB designed the DCE.

BC and NKB participated in the analysis and interpretation of the data.

All authors participated in drafting the work or revising it critically for important intellectual content.

All authors gave final approval of the version to be published.

All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgements: Dr John Rose advised on the design of the discrete choice experiment (DCE).

Getahun Wajebo and Worke Mekuriya conducted the interviews and gave invaluable advice on Ethiopian culture, translation and survey organisation.

Donna Sillan and Tsegaye Bekele and the staff of Common River provided entrée to the community and logistical support.

Finally, this research would not have been possible without the support of the leadership of Titira and Woto, and the women and men in these communities who opened their homes to the research team.

Ethics approval: UCSF CHR and Hawassa University IRB.

Competing interests: None declared.


Research Funding:

This work was supported by Sigma Theta Tau International (STTI) Small Grant, STTI Alpha Eta Chapter, and UCSF Century Fund.


  • delivery services
  • discrete choice experiment
  • ethiopia
  • maternal Health

A discrete choice experiment to determine facility-based delivery services desired by women and men in rural Ethiopia


Journal Title:

BMJ Open


Volume 8, Number 4


, Pages e016853-e016853

Type of Work:

Article | Final Publisher PDF


Objectives Despite global efforts to increase facility-based delivery (FBD), 90% of women in rural Ethiopia deliver at home without a skilled birth attendant. Men have an important role in increasing FBD due to their decision-making power, but this is largely unexplored. This study aimed to determine the FBD care attributes preferred by women and men, and whether poverty or household decision-making are associated with choice to deliver in a facility. Setting and participants We conducted a cross-sectional discrete choice experiment in 109 randomly selected households in rural Ethiopia in September-October 2015. We interviewed women who were pregnant or who had a child < 2 years old and their male partners. Results Both women and men preferred health facilities where medications and supplies were available (OR=3.08; 95% CI 2.03 to 4.67 and OR=2.68; 95% CI 1.79 to 4.02, respectively), a support person was allowed in the delivery room (OR=1.69; 95% CI 1.37 to 2.07 and OR=1.74; 95% CI 1.42 to 2.14, respectively) and delivery cost was low (OR=1.15 95% CI 1.12 to 1.18 and OR=1.14; 95% CI 1.11 to 1.17, respectively). Women valued free ambulance service (OR=1.37; 95% CI 1.09 to 1.70), while men favoured nearby facilities (OR=1.09; 95% CI 1.06 to 1.13) with friendly providers (OR=1.30; 95% CI 1.03 to 1.64). Provider preferences were complex. Neither women nor men preferred female doctors to health extension workers (HEW) (OR=0.92; 95% CI 0.59 to 1.42 and OR=0.74; 95% CI 0.47 to 1.14, respectively), male doctors to HEW (OR=1.33; 95% CI 0.89 to 1.99 and OR=0.75; 95% CI 0.50 to 1.12, respectively) or female over male nurses (OR=0.68; 95% CI 0.94 to 1.71 and OR=1.03; 95% CI 0.77 to 2.94, respectively). While both women and men preferred male nurses to HEW (OR=1.86; 95% CI 1.23 to 2.80 and OR=1.95; 95% CI 1.30 to 2.95, respectively), men (OR=1.89; 95% CI 1.29 to 2.78), but not women (OR=1.47; 95% CI 1.00 to 2.13) preferred HEW to female nurses. Both women and men preferred female doctors to male nurses (OR=1.71; 95% CI 1.27 to 2.29 and OR=1.44; 95% CI 1.07 to 1.92, respectively), male doctors to female nurses (OR=1.95; 95% CI 1.44 to 2.62 and OR=1.41; 95% CI 1.05 to 1.90, respectively) and male doctors to male nurses (OR=2.47; 95% CI 1.84 to 3.32 and OR=1.46; 95% CI 1.09 to 1.95, respectively), while only women preferred male doctors to female doctors (OR=1.45; 95% CI 1.09 to 1.93 and OR=1.01; 95% CI 0.76 to 1.35, respectively) and only men preferred female nurses to female doctors (OR=1.34; 95% CI 0.98 to 1.84 and OR=1.39; 95% CI 1.02 to 1.89, respectively). Men were disproportionately involved in making household decisions (X 2 (1, n=216)=72.18, p < 0.001), including decisions to seek healthcare (X 2 (1, n=216)=55.39, p < 0.001), yet men were often unaware of their partners' prenatal care attendance (X 2 (1, n=215)=82.59, p < 0.001). Conclusion Women's and men's preferences may influence delivery service choices. Considering these choices is one way the Ethiopian government and health facilities may encourage FBD in rural areas.

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© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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