This study investigated rural Lao PDR village women's views and experiences of recent, or impeding, childbirth to better understand barriers to maternity service usage. Lao PDR has the highest maternal mortality rate (MMR) in the South-East Asian region with very low utilization rates for skilled birth assistance and health sector delivery services. The study site, Sekong, a southern Lao province, was lowest in the country on virtually all indicators of reproductive and maternal health, despite several recent maternal health service interventions. The study's aim was to gain a fuller understanding of barriers to maternity services usage to contribute towards maternity services enhancement, and district and national policy-making for progressing towards 2015 MDG 4 & 5 targets.

A descriptive cross-sectional study was used. First, face-to-face questionnaires were used to collect demographic and reproductive health and health care experience data from 166 village woman (120 with a child born in the previous year, and 46 who were currently pregnant). In-depth individual interviews then followed with 23 purposively selected woman, to probe personal experiences and perspectives on why women preferred home birthing.

The majority of the woman had given at home, assisted by untrained birth attendants (relatives or neighbours). While seventy percent had accessed some antenatal services, postpartum follow-up attendance was very low (17 percent). Limited finances, lack of access to transport and prior negative health service experiences were important factors influencing women's decision making. Giving birth at home was seen by many, not just as unavoidable, but, as the preferred option.

Recent top-down maternal health initiatives have had little impact in this region. Improving maternal and child-health strategies requires much greater community participation and use of participatory action methodologies, to increase women's engagement in policy and planning and subsequent usage of health service developments.

Human ; Female ; Adult ; Young Adult ; Pregnancy ; Health Services

The aim of this study was to develop strategies for enhancing community motivation and participation in smoking control in one municipality, in the North-eastern part of Thailand. The Participatory Action Research (PAR) approach was used whereby the researchers facilitate and empower a community. Community meetings were set up for exchange of experiences and for volunteers who could participate in a counseling training program. These volunteers were screened to promote group motivation, initiate a culturally relevant medium, and to create a network for community organization. Motivation was enhanced by volunteers among three partners: 1) smokers - to become healthier through counseling about information of the harmful effects of smoking and benefits of quitting smoking; 2) families - encouraged household members to assess their health, expenditure, and outcomes if any of their own family members stopped smoking; and 3) communities - raised awareness toward smoking control among housewives, workers, seniors, and adolescent groups, who founded a sense of caring for one another as their cousins, increased the number of free-smoking zones in temples, schools, health centers, ex-smokers' houses and areas for community activities. Lessons were learned by the communities, health problems and high cost of cigarette were the greatest motivation for success, but suffering from smoking withdrawal symptoms attributed to unsuccessful quitting of tobacco. 10 out of the 19 villages continued those activities for 18 months. These villages enhanced community motivation and participation in smoking control; however, decreasing the number of new smokers remains of considerable concern.

Human ; Male ; Female ; Smoking ; Tobacco ; Motivation ; Research Personnel ; Health Expenditures ; Tobacco Products ; Counseling ; Substance Withdrawal Syndrome ; Health Services Research