BACKGROUND:
A growing number of countries in Africa and Asia document a large shift towards facility-based deliveries. These increases have often not led to the improvements in health outcomes predicted by health policy researchers. The reason for this has been attributed to poor quality care. In many low-income settings traditional care continues to attract women in spite of the availability of modern childbirth care. Attempts to integrate local tradition and cultural perceptions of safety with skilled delivery are still scarce.

OBJECTIVES:
To explore and contextualize the perceived needs, preferences and wants of women of reproductive age in pre-conflict Yemen, a high maternal mortality country with a persistent high home-birth rate.

METHODS:
We interviewed 220 women with childbirth experience in five governorates of rural/ urban Yemen through a structured closed- and open-ended questionnaire. A multistage sampling process was used. Interviews were conducted in the home of each woman by a local midwifery team. The question "What are the most important criteria for a good midwife?" was analyzed using a qualitative research approach.

RESULTS:
Women’s opinions rested on values inherent in Yemeni culture. Solidarity, support and shared authority between midwife, the woman in childbirth and women in the community were cornerstones. Ethics and the equal treatment of clients were essential to all women. The showing of patience, kindness and sisterhood translating into a willingness to share professional knowledge with clients was important to urban women. Rural women emphasized long experience and a midwife’s good reputation in the community. Helpfulness, humility and being of service were particularly important to rural women who described these qualities as key.

CONCLUSIONS:
Patient-centered and respectful care is derived from listening to women and integrating locally perceived needs in the transition towards facility deliveries. This is crucial for maternal and neonatal care strategies and women’s survival.

KEY MESSAGE:
Midwifery is an intrinsic part of culture. Poster session 2 (Group A)