Casas Maternas in the Rural Highlands of Guatemala: A Mixed-Methods Case Study of the Introduction and Utilization of Birthing Facilities by an Indigenous Population

Figures & Tables

TABLE 1 Framework for Qualitative Data Analysis

Theme	Description
Decision about birth place	Comments about how the location of birth was selected
	Sub-codes: Influence of others on delivery location Cultural traditions Previous birth experiences Perception of distance to the facility and availability of transportation Influence of costs on birth location
Birth experience	Comments related to the actual experience of giving birth
	Sub-codes: Cultural traditions Opinions about the care received at home or at a facility
Recommendations	Suggestions for improving labor and delivery services at the Casa Materna

TABLE 2 Demographic Characteristics of Survey Respondents (N = 275), by Type of Community

Demographic Characteristic	All Respondents (N = 275)	Partner Communities (n = 189)	Non-Partner Communities (n = 86)	P Value^a
Age of mother, mean, years	25.2	25.3	25.0	.93
No. of persons in household, mean	6.8	6.9	6.6	.76
No. of children in household, mean	3.2	3.4	3.0	.12
Living with spouse/partner, %	87.3	89.9	81.4	.049
Speak Chuj, %	98.9	98.9	98.8	.94
Speak Spanish, %	24.7	27.0	19.8	.20
Principally housewives, %	95.3	95.2	95.3	.71
Family received remittances in past 3 months, %	20.4	20.6	19.8	.87
Reported food insecurity in past 6 months, %	21.8	21.7	22.1	.94
Family owns a vehicle or motorcycle, %	14.5	14.3	15.1	.72
No. of years of education of mother, mean	2.7	2.8	2.6	.66
PCA asset score of household, mean	0.97	0.96	1.00	.55
Distance of mother's community from nearest Casa Materna, mean, km	5.4	4.1	8.3	<.01

Abbreviation: PCA, principal components analysis.
↵a Comparing partner communities with non-partner communities. Values shown in boldface are statistically significant at P<.05.

TABLE 3 Location of Deliveries During the Study Period (April 1, 2013–March 30, 2014) in the San Sebastian Coatán Municipality, by Type of Community

Location of Delivery	All Respondents (N = 275)	Partner Communities (n = 189)	Non-Partner Communities (n = 86)
Non-health facility deliveries	117 (42.5)	57 (28.1)	60 (69.8)
Home of interviewee or of another person	116 (42.1)	56 (29.6)	60 (69.8)
En route in ambulance	1 (0.4)	1 (0.5)	0 (0.0)
Health facility deliveries	158 (57.5)	132 (69.8)	26 (30.2)
Hospital	18 (6.5)	13 (6.9)	5 (5.8)
MPHSW health center	20 (7.3)	14 (7.4)	6 (7.0)
Private clinic	2 (0.7)	2 (1.1)	0 (0.0)
Casa Materna Calhuitz	74 (26.9)	59 (31.1)	15 (17.4)
Casa Materna Santo Domingo	44 (16.1)	44 (23.3)	0 (0.0)

TABLE 4 Thematic Analysis of Factors Affecting Decision About Birth Place

First-Order Themes	Second-Order Themes	Third-Order Themes
Barrier: Too many people involved in the decision-making process	Influence of others on delivery location	Decision about birth place
Facilitator: The role of comadronas
Facilitator/barrier: The role of husbands
Barrier: Tradition supports giving birth at home	Cultural traditions
Facilitator: The role of the comadrona
Facilitator/barrier: Effects of previous birth experiences on subsequent delivery location	Previous birth experience
Barrier: Casa Materna perceived as being located far away by some	Perception of distance
Facilitator: Casa Materna perceived as being nearby by others
Barrier: Perceived high cost of facility birth compared with home birth	Cost of childbirth
Facilitator: Perceived low cost of Casa Materna for facility birth compared with private facilities
Facilitator: Comadrona is part of the team during delivery process	Cultural traditions	Assessment of birth experience
Facilitator: Woman is attended to in her own language and with respect for long-standing traditions
Barrier: Home perceived as safe place to give birth	Perceived quality of care
Facilitator: Home perceived as an unsafe place to give birth.
Facilitator: Casa Materna perceived as providing high-quality care
Facilitator: To have more equipment	Suggestion	Recommendations for improving care at the Casa Materna