Reasons for choosing traditional birth attendants as childbirth helpers: A phenomenological study at Borong health center
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Ketut" "apellidos" => "Dharsana" ] 1 => array:2 [ "nombre" => "Ni Ketut" "apellidos" => "Suarni" ] 2 => array:2 [ "nombre" => "Gede Nugraha" "apellidos" => "Sudarsana" ] 3 => array:2 [ "nombre" => "Wayan Eka" "apellidos" => "Paramartha" ] 4 => array:2 [ "nombre" => "Mardiana" "apellidos" => "Ahmad" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862119304322?idApp=UINPBA00004N" "url" => "/11308621/00000030000000S2/v2_202305161211/S1130862119304322/v2_202305161211/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "titulo" => "Reasons for choosing traditional birth attendants as childbirth helpers: A phenomenological study at Borong health center" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "209" "paginaFinal" => "212" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Fransiska Nova Nanur, Bonavantura Nggarang, Christin Bebok, Mardiana E. Fachry" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Fransiska Nova" "apellidos" => "Nanur" "email" => array:1 [ 0 => "fransiskanova57@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Bonavantura" "apellidos" => "Nggarang" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Christin" "apellidos" => "Bebok" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Mardiana E." "apellidos" => "Fachry" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Midwifery, Universitas Katolik Indonesia Santu Paulus Ruteng, Indonesia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Nursing Study Program, Universitas Katolik Indonesia Santu Paulus Ruteng, Indonesia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Gender and Development, Graduate School, Hasanuddin University, Indonesia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The maternal mortality rate is one of the significant indicators of evaluating the health status of a country. In Indonesia, the maternal mortality rate is still on the high category. Maternal mortality is closely related to the birth attendants and the delivery facilities.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> One of the emphasized ministry's programs in Indonesia is that every delivery must be conducted on health facilities and helped by health.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The Policy of Specific Health Budget Allocation also stated that the development of public health center (PHC) have to be in line with the development of housing of health workers in said PHC. Thus, every health workers, including midwives, are ready in their workplace and prepared to assist the delivery every time they are needed. meanwhile, for a rural area with accessibility difficulties, government develop the partnership program between midwives and traditional birth attendants and a short term dwelling house for delivery called Rumah Tunggu Kelahiran.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Even though the said efforts already been conducted over the country, the coverage of delivery conducted by health workers in Indonesia is still on the low category. Nationally, the coverage rate of delivery conducted by health workers is as much 90.88% in 2013, decreased in 2014 into 88.68% and further decreased to 88.55% in 2015. Meanwhile, in NTT, the coverage of delivery conducted by professional health workers on 2013 is as much as 58.7%, in 2014 increased into 75.4%, and decreased into 62.4% on 2015.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In East Manggarai Regency, the coverage of delivery conducted by health workers per 2015 is as much as 62.8%. As in Borong Public Health Center, the coverage on 2015 was reaching 92.27% and increased to 94.90%.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> But, in 2016, about 26 mothers were reported delivered by the assistance of traditional birth attendants. Observing the description of data above, this study was conducted in order to explore the underline reason of pregnant mothers to choose traditional birth attendants to assist their delivery process over the health workers. This study is conducted on Borong Public Health Center, East Manggarai Regency, NTT Province.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Research location</span><p id="par0015" class="elsevierStylePara elsevierViewall">It was conducted on Borong Public Health Center area. This location is chosen as a research location is based on the high amount of delivery assisted by traditional birth attendants. The data collection conducted on two villages with the high category of home delivery namely Kota Ndora and Gurung Liwut.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Types and sources of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">Data collected from participants include demographic data, pregnancy examination history, and the delivery process, the reason behind choosing traditional birth attendants on assisting delivery and delivery practice of traditional birth attendants. Participant chosen by purposive method were mothers with home delivery and assisted by traditional birth attendants from October 2017 to March 2018.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Data collection techniques</span><p id="par0025" class="elsevierStylePara elsevierViewall">Data were collected through in-depth interview. In-depth interview was conducted on 16 key participants. Data were analyzed using a thematic analysis approach started with transcript writing of in-depth interviews, coding on relevant statements, and classifying the relevant statements into specific themes. Data analysis result was reported on a formal and informal manner, and the data were validated using the triangulation of data source.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Result</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study result was found the several reason of mothers choosing traditional birth attendants to assist their delivery such as:the difficulty to access the labor and delivery facilities, the custom and experience passed on across generations, the good trust on traditional birth attendants, Related to traditional birth attendants, the lack of knowledge on labor signs.</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">The difficulty to access the labor and delivery facilities</span><p id="par0035" class="elsevierStylePara elsevierViewall">The difficulty to access the labor and delivery facilities drive some of the participants to choose the near-by traditional birth attendants to assist their delivery.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The following are the interview quotation with several informants/participants:<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I want to deliver in the public health center, but when it started to pain, there was no car to the public health center, there was no motorcycle. So we call the traditional birth attendants and the delivery were going fine”.</span></p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Key Participant 10)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0010"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I am lazy to deliver in pustu (community health sub-center) due to its damaged road, and there was no car, it's impossible for me to ride a motorcycle. Delivery at home saves too. All of my children were delivered at home and helped by traditional birth attendant.”</span></p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Key Participant 9)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0015"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“We don’t prepare specific transportation to pick up every pregnant mother to deliver because we are limited on transportation facilities.”</span></p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Midwife)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0020"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“When I was in pain I night, and there were no transportation devices, I am afraid to go out.”</span></p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Key Participant 5)</p></span></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">The custom and experience passed on across generations</span><p id="par0085" class="elsevierStylePara elsevierViewall">The custom or tradition passed on by older relatives is one of the reasons that encourage pregnant mothers to choose traditional birth attendants as a delivery helper.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The following are the interview quotation with several informants/participants:<span class="elsevierStyleDisplayedQuote" id="dsq0025"><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I use to deliver at traditional birth attendants from my first child, everything is safe, no problems, so it is normal.”</span></p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Key Participant PK1)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0030"><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“From the first child to the fourth is helped by traditional birth attendants. In integrated health post (posyandu), midwives always advice us to deliver in the public health center. But my home is close to the traditional birth attendants, so when we started to feel pain, we call nene biba”.</span></p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Key Participant 11)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0035"><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I always deliver at home, ma’am. Usually, we call traditional birth attendants to help”.</span></p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Key Participant 10)</p></span></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">The trust in traditional birth attendants</span><p id="par0125" class="elsevierStylePara elsevierViewall">The trust of pregnant mothers on traditional birth attendants comforting them to choose traditional birth attendants over-delivering at health facilities.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The following are the interview quotation with several informants/participants:<span class="elsevierStyleDisplayedQuote" id="dsq0040"><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I always delivering the baby on traditional birth attendants because it's safe, no problems.”</span></p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Key Participant 6)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0045"><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I use to delivering my children at mother's home from my first child to now and all my kids were helped by traditional birth attendants. I am ashamed to give birth on integrated health post, ma’am, there are a lot of midwives, no privacy there”.</span></p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Key Participant 9)</p></span></p><p id="par0155" class="elsevierStylePara elsevierViewall">This study result also showed that one participant chooses traditional birth attendants was the child of the said traditional birth attendants.</p><p id="par0160" class="elsevierStylePara elsevierViewall">The following is the interview quotation:<span class="elsevierStyleDisplayedQuote" id="dsq0050"><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I deliver at my mom's house because my mother is a trained traditional birth attendant. From my oldest to the youngest it was my mom's help. My mom is a trained traditional birth attendant so she has equipment, gloves, and scales and everything is going fine”.</span></p><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Key Participant 2)</p></span></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">The lack of knowledge of labor signs</span><p id="par0175" class="elsevierStylePara elsevierViewall">The incapability of pregnant mothers to acknowledge the labor signs encourage the deliver assisted by traditional birth attendants</p><p id="par0180" class="elsevierStylePara elsevierViewall">The following are the interview quotes of several informants:<span class="elsevierStyleDisplayedQuote" id="dsq0055"><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“It was planned to deliver a public health center ma’am, but I thought to wait till the pain come to go to the public health center. Then nene Biba checked the baby's hair is seen out, so she just helped right away what should we do, it was different compared with our first child. It was really painful on my first child. This one is not that painful”.</span></p><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Key Participant 8)</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0060"><p id="spar0140" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">“I was planning to deliver at the public health center as the midwife told. But in that afternoon when I was selling I felt pain in my waist, I thought it was common pain, then suddenly at night, the water breaks, then my husband call nene Biba. Soon after nene Biba came, my baby was born. Alhamdulilah, everything was going fine, ma’am.”</span></p><p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">(in-depth interview with Key Participant 10)</p></span></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0205" class="elsevierStylePara elsevierViewall">Reflecting on the research findings above, it is explored the reasons encouraging the pregnant mothers in Borong public health center choose the traditional birth attendants to help the delivery over the health services.</p><p id="par0210" class="elsevierStylePara elsevierViewall">First, the transport accessibility issue to the health facilities makes the pregnant mothers choose the nearby traditional birth attendants to assist them in delivering. For example, in Gurung Liwut village which located quite far from health facilities, with the limited transport facilities and damaged roads make the pregnant mothers choose the available and close alternative to help that is the traditional birth attendants. While on Kota Ndora village, despite the location is close to Borong public health center, most of the pregnant mother that comes from fisherman families do not have their transportation facilities like a motorcycle to commute to health facilities drive them to choose the traditional birth attendants than using health services.</p><p id="par0215" class="elsevierStylePara elsevierViewall">The findings on Gurung Liwut is in line with several previous studies stated that one of the determinants related to the choice of traditional birth attendants as the delivery helper is the insufficiency of the vehicle to the health facilities.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Second, the custom and culture that is passed by the older generation enabling the pregnant mothers to choose the traditional birth attendants over the health workers as the delivery helper. The situation of Gunung Liwut village community that is very traditional and adamant to the traditional values make the pregnant mothers prioritize the traditional birth attendants to assist the labor. While in Kota Ndora, even though geographically located in the center of Borong, but the socio-cultural profile of the community is homogenous, ethnically majority comes from Ende, make them to this day keeping their previous generation habit and tradition, including delivering with the help of traditional birth attendants. This study result is in line with the study conducted by Kumbani et al. that showed that one of the reasons Malawi women choose to deliver on the help of traditional birth attendants is a sociocultural factor. Most of the respondents possess the culture that not supporting the use of health facilities.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Third, trust in traditional birth attendants. This research also found that the trust developed between pregnant mothers and traditional birth attendants encouraging them to choose the traditional birth attendants over the professional health workers. Based on the study findings, the trust developed between pregnant mothers and traditional birth attendants is created by the following three points: first, the competency of traditional birth attendants is qualified in assisting delivery. Sychareun et al also found the same reason why most of the mothers choose to deliver at home namely the comfort, calm and surrounded by the closest relatives while taking care of the older children and doing household chores.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">Fourth, the lack of knowledge of labor signs. The preference of pregnant mothers on the delivery assisted by traditional birth attendants significantly influenced by their knowledge on labor signs. This situation would not make them go to health services on-time and forcefully asked the near-by traditional birth attendants. This finding is in line with the research conducted by Titaley et al. stated that the lower knowledge on pregnancy and delivery hamper the pregnant mothers to give birth in the health facilities. The respondents presumed that health services only provide services for women with complications during delivery.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0235" class="elsevierStylePara elsevierViewall">The reasons of mothers chose traditional birth attendants to assist the delivery including the difficulty of access to health facilities, the custom, and experience passed down by older generations, the high trust to the traditional birth attendants, the family relationship with the traditional birth attendants and the lack of knowledge of labor signs. Thus, the harder effort of health workers is necessary through the consistent approach to the society and develop the partnership with the traditional birth attendants in order to achieve the 100% coverage of delivery conducted by health workers.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0245" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1898986" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1642799" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Research location" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Types and sources of data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data collection techniques" ] ] ] 4 => array:3 [ "identificador" => "sec0030" "titulo" => "Result" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "The difficulty to access the labor and delivery facilities" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "The custom and experience passed on across generations" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "The trust in traditional birth attendants" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "The lack of knowledge of labor signs" ] ] ] 5 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack667125" "titulo" => "Acknowledgments" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-05-29" "fechaAceptado" => "2019-07-15" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1642799" "palabras" => array:3 [ 0 => "Labor" 1 => "Traditional birth attendant" 2 => "Qualitative" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aimed to investigate the reasons why the mothers choose a traditional birth attendant as a birth delivery helper at Borong Health Center in East Nusa Tenggara Province.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">It was a qualitative study with in-depth interviews was conducted for the present study. The participants (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16) were selected purposely, consisting of eleven mothers who gave birth at home and were assisted by traditional birth attendants, two midwives, and two active traditional birth attendants, one community leader and the head of the community health center. Open interview guidelines were used to explore the reasons why mothers still choose traditional birth attendants for their birth deliveries. Data were analyzed by thematic analysis approach.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The results of the study show that the unavailability of transportation facilities to health facilities, ancestral traditions, kinship with the traditional birth attendant, poor weather during delivery and poor road conditions made it difficult for mothers and families to go to health facilities.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Thus, situated by many factors, the pregnant women at Borong Health Center still choose traditional birth attendant as their delivery helper.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the International Conference on Women and Societal Perspective on Quality of Life (WOSQUAL-2019). 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