“Even though they insult us, the delivery they give us is the greatest thing”: a qualitative study contextualizing women’s experiences with facility-based maternal health care in Ethiopia

Abstract

Background Globally, amidst increased utilization of facility-based maternal care services, there is continued need to better understand women’s experience of care in places of birth. Quantitative surveys may not sufficiently characterize satisfaction with maternal healthcare (MHC) in local context, limiting their interpretation and applicability. The purpose of this study is to untangle how contextual and cultural expectations shape women’s care experience and what women mean by satisfaction in two Ethiopian regions. Methods Health center and hospital childbirth care registries were used to identify and interview 41 women who had delivered a live newborn within a six-month period. We used a semi-structured interview guide informed by the Donabedian framework to elicit women’s experiences with MHC and delivery, any prior delivery experiences, and recommendations to improve MHC. We used an inductive analytical approach to compare and contrast MHC processes, experiences, and satisfaction. Results Maternal and newborn survival and safety were central to women’s descriptions of their MHC experiences. Women nearly exclusively described healthy and safe deliveries with healthy outcomes as ‘satisfactory’. The texture behind this ‘satisfaction’, however, was shaped by what mothers bring to their delivery experiences, creating expectations from events including past births, experiences with antenatal care, and social and community influences. Secondary to the absence of adverse outcomes, health provider’s interpersonal behaviors (e.g., supportive communication and behavioral demonstrations of commitment to their births) and the facility’s amenities (e.g., bathing, cleaning, water, coffee, etc) enhanced women’s experiences. Finally, at the social and community levels, we found that family support and material resources may significantly buffer against negative experiences and facilitate women’s overall satisfaction, even in the context of poor-quality facilities and limited resources. Conclusion Our findings highlight the importance of understanding contextual factors including past experiences, expectations, and social support that influence perceived quality of MHC and the agency a woman has to negotiate her care experience. Our finding that newborn and maternal survival primarily drove women’s satisfaction suggests that quantitative assessments conducted shortly following delivery may be overly influenced by these outcomes and not fully capture the complexity of women’s care experience.

’God is the one who give child’: An abductive analysis of barriers to postnatal care using the Health Equity Implementation Framework

“…This study used data collected as part of an earlier study that evaluated a district-wide health systems quality improvement intervention in Ethiopia by the Institute for Healthcare Improvement (IHI) and the Ethiopian Ministry of Health using mixed-methods. 37 Semi-structured, in-depth interviews were conducted between March and April 2018 and in April 2019. The study team and health leaders at each study site collaborated to purposefully select one hospital and one health center in each woreda that was representative of the catchment area's diverse birthing experiences.…”

Institutional delivery and maternal health: Anthropological insights from Southwest Ethiopia

“…For instance, Hannig's (2017) ethnographic study of Fistula in Addis Ababa and Amhara Region and Hagaman et al's (2022) qualitative study on "contextualizing women's experiences with facility-based maternal health care in Ethiopia" are worth mentioning. Hagaman et al (2022) conducted a qualitative study in two of the nine Ethno-linguistic Federal States and two City Administrations in Ethiopia. They collected data from 41 participants.…”

“…In this regard, studies in selected areas of Ethiopia have tried to bridge the gap. For instance, Hannig's (2017) ethnographic study of Fistula in Addis Ababa and Amhara Region and Hagaman et al. 's (2022) qualitative study on “contextualizing women's experiences with facility‐based maternal health care in Ethiopia” are worth mentioning.…”

“…Hagaman et al. (2022) conducted a qualitative study in two of the nine Ethno‐linguistic Federal States and two City Administrations in Ethiopia. They collected data from 41 participants.…”

“…They collected data from 41 participants. They reported that their study was “part of a mixed‐methods program evaluation of a district‐wide health systems quality improvement intervention implemented by the Institute for Healthcare Improvement (IHI) Ethiopia in partnership with the Ethiopian Ministry of Health” (Hagaman et al., 2022, 3). The other studies by Hannig (2014, 2015, 2017) shed light on issues surrounding maternal health, especially obstetric fistula in Amhara Regional State.…”