Factors influencing women's and men's place of birth decisions in rural Western Highlands Province of Papua New Guinea: A qualitative descriptive study

Background: Evidence shows that birthing with a skilled birth provider improves maternal and neonatal health outcomes. However, whilst most women in the Western Highlands Province of Papua New Guinea seek skilled health care during pregnancy in a health facility, more than half give birth at home or in the village without a skilled birth provider.

Aim: To explore the factors influencing women's and men's decisions about place of birth in rural Western Highlands Province of Papua New Guinea.

Method: A qualitative-descriptive study was conducted. Semi-structured, in-depth interviews were conducted with 20 participants (16 women who were pregnant or recently given birth and four men whose partners were pregnant or recently gave birth). Interviews were audio-recorded and transcribed verbatim. The data was thematically analysed.

Results: Three key themes associated with the place of birth decision factors were identified from the study findings: (1) health service accessibility and availability, (2) socio-cultural influences, and (3) previous maternity care experiences. Participant experiences influenced their choice of place of birth, resulting in many giving birth at home in their village without a skilled birth provider.

Conclusion: Maternal and child health services need to be appropriately tailored to improve accessibility and meet the unmet needs of pregnant women in Papua New Guinea. Additionally, health education programs should address socio-cultural factors influencing the uptake of healthcare services, especially in rural areas where health disparities are more evident. Further research is required to explore health worker perspectives, patriarchal control, and respectful care regarding health service utilisation in this study context.