Abstract
BackgroundPakistan has alarmingly high numbers of maternal mortality along with suboptimal care-seeking behaviour. It is essential to identify the barriers and facilitators that women and families encounter, when deciding to seek maternal care services. This study aimed to understand health-seeking patterns of pregnant women in rural Sindh, Pakistan.MethodsA qualitative study was undertaken in rural Sindh, Pakistan as part of a large multi-country study in 2012. Thirty three focus group discussions and 26 in-depth interviews were conducted with mothers [n = 173], male decision-makers [n = 64], Lady Health Workers [n = 64], Lady Health Supervisors [n = 10], Women Medical Officers [n = 9] and Traditional Birth Attendants [n = 7] in the study communities. A set of a priori themes regarding care-seeking during pregnancy and its complications as well as additional themes as they emerged from the data were used for analysis. Qualitative analysis was done using NVivo version 10.ResultsWomen stated they usually visited health facilities if they experienced pregnancy complications or danger signs, such as heavy bleeding or headache. Findings revealed the importance of husbands and mothers-in-law as decision makers regarding health care utilization. Participants expressed that poor availability of transport, financial constraints and the unavailability of chaperones were important barriers to seeking care. In addition, private facilities were often preferred due to the perceived superior quality of services.ConclusionMaternal care utilization was influenced by social, economic and cultural factors in rural Pakistani communities. The perceived poor quality care at public hospitals was a significant barrier for many women in accessing health services. If maternal lives are to be saved, policy makers need to develop processes to overcome these barriers and ensure easily accessible high-quality care for women in rural communities.Trial RegistrationNCT01911494Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0140-1) contains supplementary material, which is available to authorized users.
Highlights
Pakistan has alarmingly high numbers of maternal mortality along with suboptimal care-seeking behaviour
When asked directly all women knew the terminology of high blood pressure and, stated that high blood pressure can occur during pregnancy
This study reported that women and decision-makers are often not familiar with the importance of routine antenatal care
Summary
Pakistan has alarmingly high numbers of maternal mortality along with suboptimal care-seeking behaviour. It is essential to identify the barriers and facilitators that women and families encounter, when deciding to seek maternal care services. Understanding health seeking behaviour in a community is necessary for the development of appropriate health policies, health systems and educational strategies to facilitate access. Behavioural models can be used to illustrate the dynamics of the individual, community and care providers in such decisions [1]. Andersen’s behavioural model describes three categories of determinants at play in health care decision making: predisposing characteristics, enabling characteristics, and need [1]. Predisposing characteristics include the individual’s demographics, their social structure as well as their beliefs regarding the benefits of health services. Enabling characteristics encompass personal and community resources that encourage usage of health services. The third category relates to the perceived and actual need for services
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