Status, associated factors, and reasons for bypassing the childbirth center among postpartum women in the Dire Dawa Administration, Ethiopia: A Mixed Study

Background: Obstetrics care in a nearby health facility is an important strategy to reduce maternal and child complications, including death during childbirth. Bypassing the nearby birthing health facility is common in developing countries, including Ethiopia. But, in Ethiopia and the study area, little is known about the extent, determinants, and reasons for bypassing them. Therefore, this study was aimed at assessing all these gaps, which are an important indicator of the quality of obstetrics care that the health system needs to address. Methods: A facility-based mixed (quantitative cross-sectional and phenomenological qualitative) study was conducted at selected public health centers in Dire Dawa city from December 01 to 30, 2022. A simple random sampling technique was used to select 635 participants for the quantitative study and purposive sampling for the qualitative study. Data were collected through face-to-face interviews using a pre-tested structured questionnaire and semi-structured questions for in-depth interviews. Quantitative data were entered and cleaned by Epi DATA (Version 3.1) and analyzed using SPSS (Version 22). A P-value < 0.25 at bivariate to select variables for multivariate and ≤ 0.05 at multivariate with 95% confidence intervals was considered statistically significant. Qualitative data were analyzed using thematic analysis using open-source software. Results: 635 postpartum women for quantitative and twelve participants for qualitative were included. At childbirth centers, the overall bypass rate was 30.9% (95% CI: 27.1%–34.55 %). A higher age group (AOR = 2.34, 95% CI: 1.43–3.82), rural residence (AOR = 1.89, 95% CI: 1.11-3.22), no formal education (AOR = 2.26, 95% CI: 1.23–4.16), obstetric care needs during antenatal care (AOR = 2.37, 95% CI: 1.33–4.22), and health professionals’ behavior (AOR = 2.37, 95% CI: 1.33–4.22) and health professionals’ behavior (AOR = 3.10, 95% CI: 1.99–4.78) were associated with a higher likelihood of bypassing. Health care facility, personal perception, and health care worker-related factors were the main identified themes in the qualitative results. Conclusion: The extent of bypassing the nearby childbirth health facility was moderate and associated with women’s age, education, resident area, obstetrics care during antenatal visits, and health care workers’ approaches. In the qualitative analysis, three major themes emerged for the reasons for bypassing a nearby childbirth health facility: the health care facility, health professionals, and service users’ perception-related reasons. Stakeholders were advised to increase obstetrics services (supplies, equipment), respectful care, and education while taking pregnant women's residence and education level into account, as well as conduct additional community-based research.