Perceptions of Inequity in the Provision and Utilization of Maternal, Newborn, and Child Health Services in Tigray, Ethiopia. A Qualitative Explorative Study

Abstract

Background: We have earlier shown that the utilization of Ethiopian maternal health services was distributed pro-rich, while child immunization was equitably distributed. Hence, this study aimed at exploring rural Ethiopian women’s and primary health care workers’ perceptions of inequities and their causes in the provision and utilization of maternal, newborn, and child health services. Methods: The study was conducted from August to December 2019 in two rural districts of Tigray, Ethiopia. We performed twenty-two in-depth interviews and three focus group discussions with women who had given birth the last year preceding the survey, women’s development group leaders, health extension workers from health posts, and health workers from health centers. The final sample was determined based on the concept of saturation. The interviews and focus group discussions were audiotaped, transcribed, translated, coded, and analyzed using thematic analysis. Results: The provision and utilization of antenatal care, facility-based delivery, and care-seeking for sick children were perceived inequitably distributed. Immunization was perceived as an equitable service. The inequity in the provision and utilization of maternal and child health services was linked to the economy, distance, social and cultural norms, low quality of service, maternal age, and education. Poor implementation of the Government’s equity-oriented policies, such as community-based health insurance, was perceived to result in health inequities. Conclusion: Mothers and primary healthcare providers in rural Ethiopia indicated weaknesses in delivering equitable services and reasons for inequitable utilization. The narratives could inform efforts to provide universal health coverage for mothers, newborns, and children. These problems require multisectoral actions to address the identified sources of inequities.