In this study fear of childbirth among pregnant women attending ANC services in public health facilities in Arba Minch town was investigated. Since almost all pregnant women had some degree of childbirth fear, we used a W-DEQ sum score of 85 or more as women having a severe degree (considerable) fear of childbirth and the discussion was based on this cut-off point. Accordingly, the proportion of women with a considerable fear of childbirth in this study was 24.5% (95%CI: 20%, 29%). The finding from this study is similar to other studies conducted in Malawi (20%), Iran (20%) and Australia (24%) [5, 12, 24]. However, the cut-off points used in this study (≥ 85) and studies conducted in Malawi (≥ 66) and Australia (≥ 66) is different indicating that the burden of the problem is still higher among women in this study area. It is also higher than the findings from a study which included six European countries and has used similar cut-off point for severe degree of childbirth fear where the prevalence of FOC ranged from 4.5 among primigraviadae in Belgium to 15.6 among primigraviadae in Estonia[25] and a result from a recent study conducted in Kenya where the prevalence of severe degree of childbirth fear was 8% [26]. On the contrary, findings from studies conducted in India (45.4%),[27] the United States of America (39.4%)[28] and Turkey (82.6%)[24] have shown higher burden of the problem than results from this study.
These discrepancies may be due to the differences in culture and attitudes towards childbirth, differences in health institutions structure, quality of ANC, and the difference in tools used to measure the degrees of fear. Moreover, the inconsistency with the cut-off points to define the degree of childbirth fear can also affect the difference in the magnitude of the problem. For instance, some studies used 50, other 66, some 85 as cut-off point [25–27]. Overall we can see that fear of childbirth is common among pregnant women across the world but the way the problem is reported has subjectivity which needs common consensus.
In the current study, unplanned pregnancy was strongly associated with FOC, which is supported by findings from a study conducted in Turkey, a study from six European countries and a study from Bangkok[25, 29–31]. The reason behind this may be due to an increase in stress among women with an unplanned pregnancy in addition to pregnancy physiological maladaptation. It is likely that the pregnancies are close to the previous ones that there might be obstetrical cases that demanded spacing the regencies. Unplanned pregnancy means the woman has more likely to have another life plan and the co-existence of the two conditions might have increased the degree of fear among these women. This is also supported by another study conducted in Turkey where women with unplanned pregnancy had problems with adaptation to pregnancy, felt more pain during labor and were at high risk of depression during puerperium [32, 33].
The other factor which had significant association with FOC in this study was the presence of complications during pregnancy. Women who had pregnancy-related complications during the current pregnancy have more likely to have a fear of childbirth than those who were not. This finding is supported by study findings from a study conducted in Turkey [30]. The possible justification may be due to inadequate individualized counseling that women should get and stress from rumors and information they gather from the previous experience or other women or media and thus increases level fear of childbirth. Fear of being dying, baby injury, poor control of the body, lack of trust in health care professionals, lack of confidence to give birth and others may also increase if adequate counseling was not given to those women with pregnancy-related complications. Other study also reported the positive correlations between childbirth fear, and other problems during pregnancy [34].
Moreover, pregnant women who had poor social support were more likely to have FOC. This is in line with the study done in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden), Finland and the United States [25, 28, 35]. Another study conducted in Norway also supports the findings [36]. The possible justification may be due to the strong support by family, neighbor, or midwives can strengthen women's belief that childbirth is a physiological and controllable process, and thus, result in psychological wellbeing and reduced fear of childbirth. For women who had support from husband, family, mother or mother-in-law together with a trained midwife may reduce fear.
Bringing fear of childbirth into the light as a problem among Ethiopian women may be taken as the strength of the study as most of the people including the women in the country themselves have not been considering the situation as a problem. However, we could not assess some variables which might have an important association with the problem like the history of abuse/violence during pregnancy with the tool.