Determinants of Low Maternal and Newborn Health Service Utilization in Haiti: A Community-Based Cross-Sectional Study

Abstract

Background: Haiti suffers from among the world’s poorest maternal and newborn health (MNH) indicators and utilization of skilled MNH care remains alarmingly low. In 2013, Enfants du Monde (EdM) and Doctors of the World Switzerland initiated a project aiming to empower women and communities to improve MNH and increase demand for skilled care. During 2013 participatory community assessment (PCA) was conducted, followed by a cross-sectional baseline study in 2014 to better understand the situation and lay the groundwork for implementation of interventions. Methods: A cross-sectional design was adopted for the study, using a mixedmethods approach. The quantitative component consisted of a randomized survey of 320 women who had given birth during the previous year living in the intervention area. Qualitative methods included focus groups discussions with women (n=8) and male partners (n=2) and semi-structured interviews (n=10) with health workers. Results: The baseline study revealed a number of factors which contribute to low use of MNH services in Haiti, with lower utilization in rural compared to urban areas. Notably, while use of antenatal care (ANC) remains relatively high, with 83% of women receiving ANC 1, only 34% of women give birth in the presence of a skilled birth attendant. Awareness of maternal health needs remains low, with few respondents able to cite three danger signs during pregnancy (63%), birth (41%) and after birth (39%). FGDs with men revealed low knowledge, as well. Geographic and financial barriers remain important obstacles. In addition, women express low satisfaction regarding health services and interactions with providers. Discussion: These results of the study demonstrate that a number of factors come into play impacting on women’s decision to seek care, reach health facilities and obtain skilled MNH care once at health facilities. While geographic and financial barriers remain important, other obstacles are also critical, including the social status of women, preference of care from matrones—traditional birth attendants (TBA) practicing widely in Haiti, and low perceptions of the quality of care and treatment by health care professionals. Conclusion: These studies revealed a number of factors which contribute to preventing women and newborns from accessing MNH services. Effectively improving MNH in Haiti requires action at both the community- and health services-level to address the multitude of factors contributing to low utilization of services.