There is low use of health facilities for childbirth in South Sudan despite the majority of households reporting access to a health facility. South Sudan has a high maternal mortality ratio with 789 maternal deaths for every 100,000 live births. The absence of a midwife during labor and delays in reaching health facilities for childbirth remain the leading contributing factors to the high maternal mortality. Little is known, however, about factors influencing use and non-use of health facilities for delivery in the country. This phenomenological study, therefore, seeks to build a body of evidence by describing the experiences of women using health facilities for childbirth. Applying the health belief model, structured interviews were conducted confidentially with 20 women between the ages of 18 and 45 who delivered at the Juba Teaching Hospital. Interviews were voice recorded, transcribed, and analyzed by hand-coding and through NVivo computer software. A review of copied data, comparison with field notes, and member checking were done to ensure data quality. Five broad themes emerged based on the research questions and linked these to the theoretical model. Findings revealed that women received support and assistance during their childbirth experience at the hospital from their husbands, mothers-in-law, health workers, and neighbors. Women reported negative factors such as hunger and positive factors such as care provided by midwives as affecting their childbirth experiences. This research could contribute to improving health outcomes for women and newborns. This study has implications for positive social change by transforming the provision of maternity services in South Sudan.

In India, globalized flows of bio-medical discourse, practices and technologies are reshaping the field of reproductive healthcare, and the performance of childbirth more specifically. These projects aim to produce institutional delivery rooms that are "safe and modernized" by equating the utilization of westernized, obstetric techniques for managing delivery with better birth outcomes. Yet, these projects often evoke dynamic tensions between the imagined labor rooms NGOs seek to produce and the lived realties of labor in a local context. In this thesis, I examine the ways NGOs market and disseminate state and global discourses around safe, institutional delivers to local communities through a case study of one NGO working in rural southern Rajasthan. Drawing on data from participant observation and in-depth, semi-structured interviews with NGO staff and skilled-birth attendants employed by community health centers, I argue that at the interface of NGO, state, and global relations of power, a commodified discourse in the form of Evidenced-based Delivery (EBD) practices is emerging. This discourse is marketed through a political economy of hope that promotes EBDs as essential for safe delivery. In this system, NGOs function as conduits for transmitting idealized notions of the safe and modern delivery room, and thereby affect a shift in what skilled-birth attendants and communities come to expect from their childbirth experiences -- expectations that I argue are often difficult to meet given current training levels, limited economic resources, and a diverse set of cultural values around childbirth. My findings indicate that while Evidence-based Delivery practices may improve birth outcomes in some contexts, in the delivery rooms of rural Rajasthan, they are functioning essentially as technologies that capitalize on the political economy of hope by evoking the medical imaginary. / Graduation date: 2012

Introduction: Chronic malnutrition (Stunting) is one of the main problems in developing countries. On the other hand, the health of the mother and her timely access to a health service is a relevant aspect, but the relationship that the fact of being born in a non-institutional environment has on chronic malnutrition in children under 5 is not yet known. Objectives: Our analysis aims at evaluating the association between institutional delivery and chronic malnutrition in the first 5 years of life using the ENDES-2017 database in low and very low socioeconomic levels. Methods: Analytical cross-sectional observational study with data from the Demographic and Family Health Survey (ENDES). All the analyses were carried out considering the complex sample design (svy), considering that the database comes from a survey at the time of analysis. Chi square was used for bivariate analysis for categorical variables. Crude prevalence ratios (RPc) and adjusted (RPa) were obtained through the construction of generalized linear models, using the Poisson family and the log link function. A confidence level of 95% was considered, significant p <0.05. Results: A total of 11,734 records were analyzed. The prevalence of chronic malnutrition in children under 5 years of age was 20.50% and the prevalence of non-institutional delivery was 15.53%. 92.47% of the children who received their complete vaccinations up to one year of life had institutional delivery in urban areas, while only 85.71% in rural areas. The multivariate analysis shows that not having an institutional delivery increases the probability of developing chronic malnutrition by 1.42 times. The higher the mother’s educational level, the less likely the minor is to develop chronic malnutrition. The greater the number of children under 5 years of age, the greater the risk of developing chronic malnutrition (PR: 1.39 and 1.67). Conclusion: It cannot be concluded that there is an association between non-institutional childbirth and chronic malnutrition in children under 5 years of age from low and extremely low socioeconomic levels in Peru. / Introducción: La desnutrición crónica es uno de los principales problemas en los países en vías de desarrollo. La salud de la madre y su acceso oportuno a un servicio de salud es un aspecto relevante, pero aún no se conoce la relación que tiene el hecho de nacer en un ambiente no institucional sobre la desnutrición crónica en niños menores de 5 años. Objetivos: Nuestro análisis, está orientado a evaluar la asociación entre parto institucional y la desnutrición crónica en los primeros 5 años de vida usando la base de datos ENDES-2017 en los niveles socioeconómicos bajo y muy bajo. Métodos: Estudio observacional transversal analítico con datos de la Encuesta de Demográfica y Salud Familiar (ENDES). Los análisis fueron realizados considerando el diseño de muestras complejas (svy). Se usó chi cuadrado para el análisis bivariado para variables categóricas. Se obtuvieron las razones de prevalencias crudas (RPc) y ajustadas (RPa), a través de la construcción de los modelos lineales generalizados, usando familia Poisson y la función de enlace log. Nivel de confianza del 95%, p significativa <0,05. Resultados: Un total de 11734 registros fueron analizados. La prevalencia de desnutrición crónica en niños menores de 5 años fue de 20,50% y la prevalencia de parto no institucional fue de 15,53%. El 92,47% de los niños que recibieron sus vacunas completas hasta el año de vida si tuvieron parto institucional en área urbana mientras que en el rural solamente 85,71%. El análisis multivariado muestra que no haber tenido un parto institucional incrementa en 1,42 veces la probabilidad de desarrollar desnutrición crónica. A mayor nivel educativo de la madre, menores probabilidades tiene el menor de desarrollar desnutrición crónica. A mayor número de hijos menores de 5 años, mayor es el riesgo de desarrollo de desnutrición crónica (RP: 1,39 y 1,67). Conclusión: No se puede concluir que exista una asociación entre el parto no institucional y la desnutrición crónica en niños menores de 5 años en niveles socioeconómicos bajos y muy bajos en el Perú. / Tesis