Barriers to accessing adequate maternal care in Latvia: A mixed-method study among women, providers and decision-makers

Abstract

Maternal health outcomes in Central and Eastern Europe (CEE) compare unfavorable with those in Western Europe, despite macro-indicators that suggest well-designed maternal care systems. However, macro-indicators at the system level only capture capacity, funding and utilization of care and not the actual allocation of financial and human resources, the quality of care and access to it. It is these latter which are problematic in the CEE region. In this study service-related indicators of access to maternal care in CEE are examined. These include availability, appropriateness, affordability, approachability and acceptability of maternal care. This study uses a qualitative systematic literature review, analyzing information of peer-reviewed articles published since 2004. Other inclusion criteria included language, setting and publication purpose. The included articles were analyzed using a framework analysis technique and quality was assessed using standardized evaluation checklists. Results indicate improvements in maternal care. However, availability of care is limited by outdated equipment and training curricula, and the lack of professionals and pharmaceuticals. Geographical distance to healthcare institutions, inappropriate communication of providers and waiting times are the main approachability barriers. Some mothers are unaware of the importance of care or are discouraged to utilize healthcare services because of cultural aspects. Finally, a major barrier in accessing maternal care in the CEE is the inability to pay for it. Our findings indicate that major gaps in evidence exist and that more representative and better quality data should be collected. Governments in CEE countries need to establish a reliable system for measuring and monitoring a suitable set of indicators, as well as deal with the general social and economic problem of informality. Medical curricula in the CEE region need to be overhauled and there should be a focus on improving the allocation of medical staff and institutions as well as protecting vulnerable population groups to ensure universal access to care.

Health-Related Behaviors of Pregnant Women Residing in Urban and Rural Areas in Poland

“…Our study suggests that, despite the universal access to information for both rural and urban inhabitants and development of prenatal care, there is still a need for education about proper nutrition and other health-related issues regardless of place of residence. These suggestions are also supported by Ługowska et al and Dereń et al [38,39] and in other populations [40]. Progress in antenatal care has been made worldwide, which is also supported by our results [41].…”

Maternal health services for pregnant adolescent girls in Uganda: Barriers and Opportunities

“…Remunerating health workers would also enhance job satisfaction. This is similar with Miteniece et al (32), who noted that it is necessary to improve health workers' satisfaction in order to improve their efficiency within the medical sector. Through remuneration, government can be able to maintain as well as stimulate the efficiency of workers when rendering health care services.…”

Uptake of Skilled Maternal Healthcare in Ethiopia: A Positive Deviance Approach

“…Community level factors are geographical accessibility, residing in a community where women have higher levels of health knowledge, decision-making autonomy, low community poverty rate, and availability of community media [16]. At the policy level, government health strategies aimed at improving utilization of skilled maternal services have influenced uptake and utilization of maternal healthcare services [17][18][19].…”

“…Their strategies result in improved health outcomes, favorable health behaviors or increased adherence to policy advice, despite exhibiting risk factors indicating otherwise [21][22][23][24][25][26][27]. Research adopting a PD strategy when exploring factors influencing the use of maternal healthcare services is however still in its infancy [22], as existing literature in general focuses on all women in the reproductive age [14][15][16][17][18][19]. Identifying Ethiopian mothers with positive health behaviors despite an adverse risk profile and exploring their characteristics could help health policy implementation, enable program managers to optimize public health initiative's performance, and ultimately improve population health.…”