Barriers and facilitators to reproductive health service utilization in Cote d’Ivoire: A community-based qualitative study

Abstract

Improving Reproductive Maternal Newborn Child Adolescent Health Plus Nutrition (RMNCAH+N) indicators is a challenge for health systems, especially those in sub-Saharan Africa. The objective of this study was to identify barriers and facilitators to the use of RMNCAH+N services in areas with low indicators in Cote d’Ivoire. A qualitative case study was conducted in September 2021, with 76 beneficiaries of RMNCAH+N services in the health districts of Boundiali, Toulepleu and Tanda. Individual interviews (09) and focus groups (09) were conducted with community leaders/tradi-practitioners/midwives and pregnant women/ women of childbearing age/men who have or are responsible for a child under the age of 5, respectively. A thematic analysis was performed after coding the data in NVivo 12. Barriers to utilization of RMNCAH+N services were unavailability of certain equipment/amenities, disrespectful care in some RMNCAH+N services, women’s lack of financial autonomy, lack of autonomy in decision making, and male healthcare providers. Facilitators identified were geographic accessibility, men’s involvement in the mother-child dyad’s health, and community awareness. Improving utilization of RMNCAH+N services requires the implementation of interventions that address these barriers and facilitators, such as raising community awareness of RMNCAH+N services and promoting respectful, patient-centered, humanized care among healthcare providers.