In Eastern Ethiopia, where progress concerning maternal health service utilization stagnates, a new qualitative study sheds light on the complex factors that discourage women from accessing the much-needed maternal healthcare. The findings, published in the journal Women and Birth, reveal a tapestry of societal, cultural, and systemic barriers in a setting where maternal mortality remains alarmingly high.
Introduction to the Issue
Ethiopia, like many low-income countries, grapples with a substantial burden of maternal mortality. Complications during pregnancy and childbirth can be deadly in places where access to quality health services is limited or underutilized. This reality begs an exploration of the factors behind such underutilization.
The study, conducted by Tesfaye Gezahegn of Haramaya University and colleagues from the University of Newcastle, Australia, adopts a qualitative methodology to delve into the reasons behind the delayed use of maternal health services in Eastern Ethiopia. The use of qualitative methods allows for an in-depth understanding of the attitudes and behaviors that underpin health service usage, going beyond what quantitative data can reveal.
Methodology
The research team conducted 13 audio-recorded focus group discussions with 88 participants, encompassing a diverse group of stakeholders including reproductive-aged women, mothers-in-law, traditional birth attendants, husbands, and Health Extension Workers. This multi-perspective approach allowed the researchers to capture a comprehensive view of the community’s beliefs and practices around maternal health.
The findings were thematically analyzed using the Three Delays model, which posits that delays in seeking, reaching, and receiving care are responsible for preventable maternal mortality.
Key Findings: Delay Factors in Service Utilization
From the discussions, a myriad of factors emerged contributing to the underuse of maternal health services:
Delay One: Decision to Seek Care
1. Low level of awareness of the need for healthcare services was a notable barrier. Many participants lacked knowledge about the benefits of utilizing maternal health services.
2. The role of the husband in maternal health was also highlighted as a key factor, with poor male involvement often standing in the way of healthcare decisions.
3. Some women perceived a lack of health problems and thus did not see the need for services, while social and cultural mores accorded significant power to social figures like mothers-in-law and traditional birth attendants, limiting healthcare utilization.
4. Negative attitudes towards male midwives and traditional preferences for traditional birth attendants over skilled birthing care were also notable.
5. Finally, the participants pointed out the poor social networking within communities that lead to reduced information sharing and support for maternal health service utilization.
Delay Two: Reaching the Facility
Economic and infrastructure considerations came to the fore, with a lack of physical accessibility and high transportation costs posing significant challenges for pregnant women trying to reach healthcare facilities.
Delay Three: Receiving Adequate Care
Poor quality of care was a commonly cited barrier. Participants noted both perceived and experienced inadequacies in the care provided, which discouraged trust and reliance on the existing healthcare framework.
Discussions and Implications
This study has crucial implications for health policy and programming in Ethiopia. The identification of barriers across the Three Delays is integral to devising interventions that tackle each specific delay point. The multifaceted nature of the reasons behind these delays suggests that a single-strategy approach would not suffice; an overarching, multifaceted response is warranted.
The researchers of the study advocate for educational campaigns to enhance awareness, male involvement programs to foster collective decision-making in families, and community collaboration to break down harmful cultural perceptions. Moreover, improving infrastructure and reducing costs could ease physical access to facilities, while efforts to improve the quality of care could restore trust in the healthcare system.
Conclusion
This qualitative study provides a critical insight into the factors delaying maternal health service utilization in Eastern Ethiopia. The adoption of a tailored, holistic response to these factors is necessary to improve maternal health outcomes in the region.
DOI and References
DOI: 10.1016/j.wombi.2019.04.006
1. Gezahegn, T., Chojenta, C., Smith, R., & Loxton, D. (2020). Delaying factors for maternal health service utilization in eastern Ethiopia: A qualitative exploratory study. Women and Birth, 33(3), e216-e226.
2. Thaddeus, S., & Maine, D. (1994). Too far to walk: maternal mortality in context. Social Science & Medicine, 38(8), 1091-1110.
3. Gabrysch, S., & Campbell, O. M. (2009). Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy and Childbirth, 9, 34.
4. Central Statistical Agency (CSA) [Ethiopia] and ICF. (2016). Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF.
5. World Health Organization. (2015). Strategies toward ending preventable maternal mortality (EPMM). Geneva: World Health Organization.
Keywords
1. Maternal Health Services Ethiopia
2. Underutilization of Healthcare
3. Qualitative Study Maternity Care
4. Barriers to Prenatal Services
5. Traditional Birth Attendant Impact