A qualitative study on barriers to utilisation of institutional delivery services in Moroto and Napak districts, Uganda: implications for programming

Abstract

BackgroundSkilled attendance at delivery is critical in prevention of maternal deaths. However, many women in low- and middle-income countries still deliver without skilled assistance. This study was carried out to identify perceived barriers to utilisation of institutional delivery in two districts in Karamoja, Uganda.MethodsData were collected through participatory rural appraisal (PRA) with 887 participants (459 women and 428 men) in 20 villages in Moroto and Napak districts. Data were analysed using deductive content analysis. Notes taken during PRA session were edited, triangulated and coded according to recurring issues. Additionally, participants used matrix ranking to express their perceived relative significance of the barriers identified.ResultsThe main barriers to utilisation of maternal health services were perceived to be: insecurity, poverty, socio-cultural factors, long distances to health facilities, lack of food at home and at health facilities, lack of supplies, drugs and basic infrastructure at health facilities, poor quality of care at health facilities, lack of participation in planning for health services and the ready availability of traditional birth attendants (TBAs). Factors related to economic and physical inaccessibility and lack of infrastructure, drugs and supplies at health facilities were highly ranked barriers to utilisation of institutional delivery.ConclusionA comprehensive approach to increasing the utilisation of maternal health care services in Karamoja is needed. This should tackle both demand and supply side barriers using a multi-sectorial approach since the main barriers are outside the scope of the health sector. TBAs are still active in Karamoja and their role and influence on maternal health in this region cannot be ignored. A model for collaboration between skilled health workers and TBAs in order to increase institutional deliveries is needed.

Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya

“…A recent study from Zimbabwe has reported similar findings; that the likelihood of facility-based delivery is not associated with maternal HIV status[22]. In addition literature suggests that risk factors for home delivery among women in general population are comparable to those in HIV-infected women [11,27,30,31]. …”

“…Risk factors contributing to the poor uptake of hospital delivery among women in the general population have included low socioeconomic status, long distance to nearest health facility, older maternal age, higher birth order, being a Muslim and/or without a religion, low education level, non-attendance of antenatal care, residing in rural areas, poor attitudes of health care providers, lack of transport, inadequate resources in health facilities, having more than two children, being in a polygamous marriage, and perceived poor quality of care during delivery in health facilities[8–12,17–20,27–30]. Social and cultural factors including previous successful home deliveries, belief that local herbs speed up labour, belief that women should exhibit endurance during child birth, lack of participation in decision making, ready availability of traditional birth attendants(TBA), and presence of male midwifes in health facilities have also been identified as deterrents to hospital deliveries[8,12,28,30].…”

“…Social and cultural factors including previous successful home deliveries, belief that local herbs speed up labour, belief that women should exhibit endurance during child birth, lack of participation in decision making, ready availability of traditional birth attendants(TBA), and presence of male midwifes in health facilities have also been identified as deterrents to hospital deliveries[8,12,28,30]. …”

Defining quality of care during childbirth from the perspectives of Nigerian and Ugandan women: A qualitative study

“…Previous research has showed perceived poor quality of care at a health facility and experiences of mistreatment during childbirth may impact women's future care‐seeking behaviors . In Nigeria and Uganda, poor perceived quality of care at facilities is a critical barrier for use of services . For example, a study in north‐western Nigeria concluded that 23.7% of women interviewed who did not deliver in a health facility cited negative provider attitudes as the primary reason for not using childbirth services, and 52.0% of women suggested that improvements in provider attitudes are necessary to increase demand for facility‐based deliveries .…”

“…For example, a study in north‐western Nigeria concluded that 23.7% of women interviewed who did not deliver in a health facility cited negative provider attitudes as the primary reason for not using childbirth services, and 52.0% of women suggested that improvements in provider attitudes are necessary to increase demand for facility‐based deliveries . Health workers’ attitudes were one of the most critical factors that affected the woman's choice of visiting a health facility or traditional provider in both Nigeria and Uganda …”