Abstract
BackgroundHumanitarian crises can lead to the rapid change in the health needs of women and newborns, which may give rise to a complex situation that would require various interventions as solutions. This study aimed to examine the health education and promotion patterns, health-seeking behaviour of mothers, and barriers to the use of maternal health services from public health facilities in two rural areas of Yemen.MethodsWe used a qualitative approach. We conducted in-depth interviews and focus group discussions with frontline health professionals and mothers respectively. Nine in-depth interviews were conducted with the health professionals, including 4 health leaders and 5 midwives, and 2 focus group discussions with mothers aged 18–45 years in Abyan and Lahj. Thematic analysis approach was used to analyze the data in Atlas.ti (version 8) Software.ResultsOur data showed that health education and promotion activities on maternal health were ad hoc and coverage was poor. Maternal health services were underutilized by women. According to the data from the focus group discussions, the poor quality of services, as indicated by inadequate numbers of female doctors, lack of medical equipment and medicines, and costs of services were barriers to use maternal health services. Moreover, the use of prenatal and postnatal care services was associated with women’s’ perceived need. However, according to the health professionals, the inadequate human resource, workload, and inadequate funding from government have contributed significantly to the perceived quality of maternal health services provided by public health facilities. Despite the identified barriers, we found that a safe motherhood voucher scheme was instituted in Lahj which facilitated the use of maternal health services by disadvantaged women by removing financial barriers associated with the use of maternal health services.ConclusionThis study identified several obstacles, which worked independently or jointly to minimize the delivery and use of health services by rural women. These included, inadequate funding, inadequate human resources, poor quality of health services, and high cost of services. These barriers need to be addressed to improve the use of reproductive health services in Yemen.
Highlights
Humanitarian crises can lead to the rapid change in the health needs of women and newborns, which may give rise to a complex situation that would require various interventions as solutions
Setting Yemen is divided into 22 governorates namely Abyan, Aden, Al-Baidha, Aldhalae, Al-Hodeida, Al-Jawf, Al-Data collection methods and tools Two InDepth Interviews (IDIs) guides and one Focused Group Discussions (FGDs) guide were used to collect data from the respondents (See supplementary material 1)
Emerging themes The findings presented are based on individual in-depth interviews with 9 health professionals and 15 mothers
Summary
Humanitarian crises can lead to the rapid change in the health needs of women and newborns, which may give rise to a complex situation that would require various interventions as solutions. Despite the reports that maternal mortality has declined at the global level since 2000, it remains an issue of public health concern. In 2017, an estimated 295,000 maternal deaths occurred worldwide. Maternal mortality is the second leading cause of death among women of childbearing age [1]. Most these preventable deaths occur in low-income and middle-income countries (LMICs). The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) noted that maternal mortality can be reduced by making improvements at the provider and health system level and reducing social and structural barriers by implementing targeting interventions [2].
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