Access to comprehensive emergency obstetric and newborn care facilities in three rural districts of Sindh province, Pakistan

Abstract

BackgroundPakistan’s maternal and child health indicators remain unacceptably high, with a maternal mortality ratio of 276 per 100,000 live births and a neonatal mortality rate of 55 per 1,000 live births. Provision of basic and comprehensive emergency obstetric and newborn care is mandated by the government; however, coverage, access, and utilisation levels remain unsatisfactory, with the situation in Sindh province being amongst the worst in the country. This study attempted to assess access to comprehensive emergency obstetric and newborn care (C-EmONC) facilities and barriers hampering access in Sindh.MethodsOne public sector hospital in each of three districts in Sindh province providing C-EmONC services were selected for a facility exit survey. A cross-sectional household survey and focus group discussions were conducted in the catchment population of these hospitals.ResultsOverall, 82% and 96% of those who utilised a public or private C-EmONC facility, respectively, incurred out-of-pocket expenditure. As expected, those living more than 5 km from the facility reported higher mean expenditure than those living within 5 km of the facility. More than half of the respondents (55%) among public sector users and the majority (71%) of private sector users could not afford travel costs. More than one third (35%) of public sector users and about two thirds (64%) of private sector users who could not afford travel costs took loans. The proportion of respondents who took loans was higher among those living more than 5 km of the health facility compared to those living within a 5 km distance. The majority of respondents (70%) in the community survey chose to go to a private sector C-EmONC facility. In addition to poverty, in terms of sociocultural access, religious and ethnic discrimination and the poor attitude of facility staff were amongst the most important barriers to accessing a C-EmONC facility.ConclusionsC-EmONC facilities in both the public and private sectors may simply not be accessible and affordable for the vast majority of poor and marginalised women in targeted districts.

Women who have not utilized health Service for Delivery in Nigeria: who are they and where do they live?

“…In addition, the women may opt for non-facility delivery if they consider the costs of delivery care to be unaffordable. Other studies have also emphasised the impact of poverty on health service use [33][34][35][36][37].…”

Bridging evidence, policy, and practice to strengthen health systems for improved maternal and newborn health in Pakistan

“…Inequity in access and the barriers to Emergency Obstetric and Newborn Care services in Sindh province are discussed by Ansari et al [ 30 ]. In addition to financial and geographical barriers, the authors highlight unfavourable attitudes and practices of healthcare providers as important barriers to seeking care from public sector hospitals.…”

Exploring women’s experience of healthcare use during pregnancy and childbirth to understand factors contributing to perinatal deaths in Pakistan: A qualitative study

“…Although 86% women attend some ANC and 66% give birth with skilled birth attendants, the proportion of births attended by private providers is not clear in Pakistan [35]. Research from the communities, like our study area, show that 70% of women prefer obstetric care from private providers [26]. Poor quality of private care in Pakistan has been previously described in a study showing high newborn mortality in an urban community using mostly birth care from private providers [36].…”

“…Women needing a CS in our study were reluctant to travel to the civil hospital in Hyderabad when they required a CS. Travel costs and other expenses of staying in a public hospital were also not affordable, approximately 82% of women using public care and 96% using private care pay out of pocket for comprehensive emergency obstetric care services in Pakistan [26]. Access to high-quality intrapartum care has been improved by financial protection strategies resulting in significant reductions in perinatal mortality [3,27].…”