Maternal and newborn healthcare utilization in Kampala urban slums: perspectives of women, their spouses, and healthcare providers

Abstract

Background It is assumed that the health conditions of urban women are superior to their rural counterparts. However, evidence from Asia and Africa, show that poor urban women and their families have worse access to antenatal care and facility childbirth compared to the rural women. The maternal, newborn, and child mortality rates as high as or higher than those in rural areas. In Uganda, maternal and newborn health data reflect similar trend. The aim of the study was to understand factors that influence use of maternal and newborn healthcare in two urban slums of Kampala, Uganda. Methods A qualitative study was conducted in urban slums of Kampala, Uganda and conducted 60 in-depth interviews with women who had given birth in the 12 months prior to data collection and traditional birth attendants, 23 key informant interviews with healthcare providers, coordinator of emergency ambulances/emergency medical technicians and the Kampala Capital City Authority health team, and 15 focus group discussions with partners of women who gave birth 12 months prior to data collection and community leaders. Data were thematically coded and analyzed using NVivo version 10 software. Results The main determinants that influenced access to and use of maternal and newborn health care in the slum communities included knowledge about when to seek care, decision-making power, financial ability, prior experience with the healthcare system, and the quality of care provided. Private facilities were perceived to be of higher quality, however women primarily sought care at public health facilities due to financial constraints. Reports of disrespectful treatment, neglect, and financial bribes by providers were common and linked to negative childbirth experiences. The lack of adequate infrastructure and basic medical equipment and medicine impacted patient experiences and provider ability to deliver quality care. Conclusions Despite availability of healthcare, urban women and their families are burdened by the financial costs of health care. Disrespectful and abusive treatment at hands of healthcare providers is common translating to negative healthcare experiences for women. There is a need to invest in quality of care through financial assistance programs, infrastructure improvements, and higher standards of provider accountability are needed.

Measuring responsiveness and mistreatment in maternity care in sub-Saharan Africa: a questionnaire validation and development of a score

“…Another strength is that the questionnaire was administered on discharge from the hospital, which decreased the potential for recall bias and improved the accuracy of answers. This contrasts with some studies which asked about birth experiences many months later, and which acknowledge that this may lead to recall bias (40,47).…”

“…Midwives reported having less time to spend with women, therefore less time to address anxieties (41), and being less tolerant of behaviours, therefore shouting more often, when the hospital was very busy (43). Differences in the informal payment culture in public and private hospitals have been reported (47) and some studies have found higher PCMC when male companions are present (48).…”

Maternal health in cities: analysis of institutional maternal mortality and health system bottlenecks in Kampala City Uganda, 2016-2021

“…47 Nonetheless, accessibility issues resulting from socio-economic vulnerability and lack of knowledge of when and where to seek care might exist in Kampala. 48…”

Emergency obstetric care access dynamics in Africa’s cities: Analysis of women’s self-reported care-seeking pathways in Kampala city, Uganda

“…19 Studies on healthcare seeking in urban settings in Africa show varied patterns such as bypassing of primary health facilities for routine care and preference of public health facilities for maternal health services. 13,20 Regarding EmOC particularly, studies have focused on the determinants of access, 21 with a few studies describing pathways (series of steps women take along their care-seeking journeys) to care. [22][23][24] Studies in urban settings in SSA elaborate travel dynamics of women in emergency situations, highlighting different patterns and determinants.…”

“…6 Long travel times, poor road infrastructure, and cost of both transport and care affect access to and use of maternal health services in urban settings. 13,14 Understanding care-seeking pathways in urban settings is necessary for improving health service delivery and ultimately improving health outcomes.…”