Barriersto accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh: A qualitative descriptive study of Indigenous women's experiences.

Shahinoor Akter,Kate Davies,Kerry Jill Inder,Jane Louise Rich,Sharon Mary Brownie

doi:10.1371/journal.pone.0237002

Abstract

Increased maternal health care (MHC) service utilisation in Bangladesh over the past decades has contributed to improvements in maternal health outcomes nationally, yet there is little understanding of Indigenous women's experiences of accessing MHC services in Bangladesh. Face-to-face semi-structured qualitative interviews with 21 Indigenous women (aged 15-49 years) within 36 months of delivery from three ethnic groups (Chakma, Marma and Tripura) were conducted between September 2017 and February 2018 in Khagrachhari district. Purposive sampling was used to recruit women representative of the population distribution in terms of age, ethnic community and service use experience. All interviews were conducted in Bangla language and audio-recorded with consent. Interviews were transcribed directly into English before being coded. Data were analysed thematically using a qualitative descriptive approach aided by NVivo12 software. Of the 21 women interviewed, 14 had accessed at least one MHC service during their last pregnancy or childbirth and were categorised as the User group. The remaining seven participants were categorised as 'Non-users' as they had not access antenatal care, facility delivery or postnatal care services. Women reported that they wanted culturally relevant, respectful, home-based and affordable care, and generally perceived formal MHC services as being only for complications and emergencies. Barriers to accessing MHC services included low levels of understanding about the importance of MHC services, concerns about service costs, limited transport and fears of intrusive practices. Experiences within health services that deterred women from accessing future MHC services included demands for unofficial payments and abusive treatment by public facility staff. Improving access to MHC services for the CHT Indigenous women requires improved understandings of cultural values, priorities and concerns. Multifaceted reform is needed at individual, community and health systems levels to offer culturally appropriate health education and flexible service delivery options.

Highlights

Improving maternal health is a global public health priority [1]
There is a lack of information regarding maternal health care (MHC) accessibility and utilisation for cultural minority groups in Bangladesh, including Indigenous women in the Chittagong Hill Tracts (CHT) [7, 8]
Cultural minority groups form based on characteristics such as religion, race, ethnicity and indigeneity and generally share a cultural identity that is different to the majority population in which they live [9]

Summary

Introduction

Improving maternal health is a global public health priority [1]. There is a lack of information regarding MHC accessibility and utilisation for cultural minority groups in Bangladesh, including Indigenous women in the Chittagong Hill Tracts (CHT) [7, 8]. Cultural minority groups form based on characteristics such as religion, race, ethnicity and indigeneity and generally share a cultural identity that is different to the majority population in which they live [9]. Bangladesh has 54 Indigenous groups with distinctive social and cultural identities, and eleven Indigenous groups live in Chittagong Hill Tracts (CHT) region [13]. Increased maternal health care (MHC) service utilisation in Bangladesh over the past decades has contributed to improvements in maternal health outcomes nationally, yet there is little understanding of Indigenous women’s experiences of accessing MHC services in Bangladesh.

Objectives

Methods

Results

Conclusion