Abstract
Acta Obstet Gynecol Scand 2002; 81: 491-501. © Acta Obstet Gynecol Scand 2002 Background. The study examined the pattern of utilization of Maternal and Child Health (MCH)-services of women with child-bearing experience in a suburb of city Kabul. Methods. A semi-structured questionnaire administered to 100 women in the community and 40 in the maternal hospital. Interviews and observations in the local MCH-clinic were used to collect the relevant information. Results. Sixty one of the 100 women in the community delivered at home exclusively, 35 having experienced both home and institutional deliveries, four women had hospital childbirths only. Approximately half of the women decided about utilizing the modern MCH services themselves. Women valued in the MCH-clinic mainly medical care and vaccinations. Delivery was seen primarily as a technical event, but when probed more deeply it was obvious, that fear of death was the driving power for decisions made. With at-home deliveries female relatives were preferred as birth assistants. If outside assistance was required, trained midwives were preferred rather than traditional birth attendants. Institutional delivery was seen as the last resource for complicated deliveries, but was also esteemed by many because of the security and cleaness. Professional skill, but also empathy and justice were appreciated in professionals. Conclusions. Promoting rooming-in and early breast feeding in the maternity wards, ongoing education of the MCH-staff about communication skills, ethics and teaching methods, dialogue with decision makers on all levels in the society about MCH including family planning, ongoing training and support of community midwives (dayas) in the community by local MCH-staff, adequate supplies, inexpensive services, incentive money for the competent staff members are recommended.