Female Health Workers Research Articles

Perception and practice of breastfeeding in public in an urban community in Accra, Ghana

BackgroundReported stigmatization and confrontation (verbal and aggressive), of women when breastfeeding in public spaces constitutes a barrier to the recommendation to breastfeed infants on demand. While such stigma of breastfeeding in public has been reported more commonly in Western country media, there is no documented evidence of this stigma in developing country settings. The current study describes community perception and experience of breastfeeding in public in Accra, Ghana. A secondary objective is to explore factors associated with breastfeeding in public.MethodsA mixed methods design comprising a survey (n = 300), five Focus Group Discussions (FGD) with lactating women (n = 50), and nine In-Depth Interviews (IDI) with adult males (n = 5) and female health workers (n = 4) were also conducted. All data were collected between May and June, 2016 in the Ayawaso-West Sub-Metropolis, Accra. Data on sociodemographic characteristics; obstetric and breastfeeding history; and also perception, experience, and practice of breastfeeding in public, were collected. FGDs and IDI data were triangulated with survey data and presented using descriptive and analytical statistics and content analysis.ResultsMajority of the survey respondents (92%) reported ever practicing breastfeeding in public. However, some reported feeling uncomfortable (52%), embarrassed (27%), or stigmatized (15%). Nevertheless, 72% of respondents felt they should be able to breastfeed anywhere. Almost all respondents (81%) reported covering their breasts when breastfeeding in public, and 70% felt private places should be used when they breastfed in public. Women in FGDs and IDI mentioned that they bottle feed their children in public places as a way to overcome the challenges of breastfeeding in public. Otherwise, they breastfeed in public because their children need to feed. Women were more likely to breastfeed in public if they reported support from a spouse (OR 3.99, 95% CI 1.50, 10.57) or other family members (OR 3.27, 95% CI 1.31, 8.18).ConclusionsAlthough women reported discomfort associated with breastfeeding in public, the practice is common. Awareness creation is needed to empower women to comfortably breastfeed and to sustain societal support of breastfeeding in public.

Gendered Dimensions of Accountability to Address Health Workforce Shortages in Northern Nigeria

Northern Nigeria has some of the worst health indices in sub‑Saharan Africa. Poor health outcomes are the result of multiple factors, including the lack of front-line health workers in rural and hard-to-reach areas. In 2012, funded by UK aid and DFID, the Women for Health programme was created to address the issue of gendered barriers of access to health education programmes and the subsequent dearth of nurses and midwives. It emerged that a different kind of ‘accountability’ was required to achieve improved maternal health outcomes: holding to account powerful actors within the community for their role in creating barriers of access to education for women and girls, as well as barriers to the retention of female health workers. This article, drawn directly from programme activities in Jigawa, Kano, Katsina, Yobe, and Zamfara states, documents strategies to shift gender norms that limit women’s professional choices and their access to quality maternal health services.

Capacity building for female community health workers - an effective tool for tobacco control and empowerment

Capacity building for female community health workers - an effective tool for tobacco control and empowerment

Knowledge, attitude and practice of breast self examination (BSE) among female health workers of selected Hospitals of Dakshina Kannada District, Karnataka

Background: The prevalence of breast cancer in Indian women is around 20% of all cancers. Health care professionals can play an significant part in teaching women. Early detection and screening is important to identify the preventive diseases. Aim: This study aimed to determine the knowledge, attitude and practice of Breast Self Examination (BSE) among female health workers. Method: This cross sectional survey was conducted among 210 health care workers from 2 different hospitals Karnataka state, India. Self administered questionnaire was used to obtain information such as demographic characteristics, knowledge, attitude and practice regarding Breast Self Examination. Statistical Analysis: Descriptive and inferential statistics was used by using SPSS 16 version. Result: Around 127 (60.47%) of participants had an average knowledge about Breast Self Examination. Utmost 193 (91.90%) have a favorable attitude towards Breast Self Examination. Majority of 68.09% (143 out of 210) have performed Breast Self Examination. Though knowledge regarding Breast Self Examination was average, only 143 (68.09%) of them practiced BSE. Conclusion: There is need to continue education programs and training sessions frequently to sensitize more people towards practicing BSE. Health care workers need to emphasize on practicing BSE more to generate awareness & periodic screening.

Qualitative Assessment of Accredited Social Health Activists (ASHA) Regarding their roles and responsibilities and factors influencing their performance in selected villages of Wardha

Background: The National Rural Health Mission has introduced village-level female community health worker, accredited social health activist (ASHA) who acts as an interface between the community and the public health system. The is study was conducted to assess the awareness and perceptions of ASHA regarding their roles and responsibilities in health-care system and factors affecting their performance in delivering health-care services. Methodology: A qualitative study was conducted in seven selected villages under Talegaon Primary Health Centers, Wardha district, Maharashtra, which is also field practice area of a medical college. Nonprobability sampling (purposive sampling) was done. In-depth interviews were conducted on ASHAs (n = 7) of those selected villages till saturation of data. Data were analyzed using the thematic framework approach. Results: ASHAs perception regarding their job responsibilities appeared to be incomplete. They had good awareness regarding their roles and responsibilities as a link worker. They were found to be mostly interested in higher incentive performances. ASHAs clarity regarding their roles and responsibilities as facilitator, social activist, and service provider was found to be somewhat compromised. They were ignorant about their roles and responsibilities under various newly launched national programs. The positive factors influencing ASHAs performances were regular supervision of their performances and appraisal by higher authority and support from community, family, and good relations with coworkers and staff. Challenges faced by most of the ASHAs were more workload, poor orientation to program, lack of quality training, and inadequate and delayed monetary incentives. Conclusion: Good quality training with regular refresher training sessions and regularization of incentives are required to motivate them ASHAs.

Individual Attributes Influencing Cervical Cancer Screening Services in Selected Health Facilities in Machakos County

In Kenya, 51.2% of estimated women population of 11 million aged 15 years and older are at risk of developing cervical cancer. Research shows that screening a woman even once between the ages of 35 and 40 years reduces her lifetime risk of cervical cancer by 25–36%. However, the effective cervical cancer screening in developing countries is as low as 18.5%. Low levels of utilization of Cervical Cancer Screening Services (CCSS) among health care workers have been documented. This study sought to determine the utilization of cervical cancer screening services by healthcare workers (HCWs) in selected health facilities in Machakos County. It was also thought imperative to determine individual HCW attributes influencing utilization of cervical cancer screening services in selected health care facilities in the county. The study adopted a descriptive cross-sectional study design involving 271 female health workers drawn from all the level 4 and level 5 facilities within the county. Respondents were stratified according to level of facility and according to their cadres. Data was collected via self-administered questionnaires and a facility assessment tool. Data analysis used SPSS version 21. Association was subjected to binary logistic regression. Only 25% of HCWs had utilized cervical cancer screening services. HCWs who had certificate (OR = 0.05, p-value < 0.01), diploma (OR = 0.04, p-value < 0.01) and degrees (OR = 0.09, p-value = 0.01) were less likely to utilize CCSS as compared to HWCs who had attained graduate studies or higher. Also health workers aged 30 years and below (OR = 0.12, p-value = 0.01) and those aged between 31 and 40 years (OR = 0.30, p-value = 0.05) were less likely to utilize CCSS as compared to healthcare workers who were aged more than 50 years. The study recommends establishment of tailor-made sensitization programs on young female health care worker aimed at increasing their uptake of CCSS services among these group.

The Effects of the Pilates Exercises on Rectus Abdominis Thickness and Balance in Healthy Female Health Worker: Prospective, Single Blind Study with Controlled Group

The Effects of the Pilates Exercises on Rectus Abdominis Thickness and Balance in Healthy Female Health Worker: Prospective, Single Blind Study with Controlled Group

Results of a community-based screening programme for diabetic retinopathy and childhood blindness in district Hyderabad, Pakistan

PurposeTo present the results of a community-based screening programme for diabetes, diabetic retinopathy (DR) and childhood blindness (CB) in District Hyderabad, PakistanMethodsProspective cross-sectional data collection from January 2014 to December...

\u201cOnce the delivery is done, they have finished\u201d: a qualitative study of perspectives on postnatal care referrals by traditional birth attendants in Ebonyi state, Nigeria

BackgroundWhile 79% of Nigerian mothers who deliver in facilities receive postnatal care within 48 h of delivery, this is only true for 16% of mothers who deliver outside facilities. Most maternal deaths can be prevented with access to timely and competent health care. Thus, the World Health Organization, International Confederation of Midwives, and International Federation of Gynecology and Obstetrics recommend that unskilled birth attendants be involved in advocacy for skilled care use among mothers. This study explores postnatal care referral behavior by TBAs in Nigeria, including the perceived factors that may deter or promote referrals to skilled health workers.MethodsThis study collected qualitative data using focus group discussions involving 28 female health workers, TBAs, and TBA delivery clients. The study conceptual framework drew on constructs in Fishbein and Ajzen’s theory of reasoned action onto which we mapped hypothesized determinants of postnatal care referrals described in the empirical literature. We analyzed the transcribed data thematically, and linked themes to the study conceptual framework in the discussion to explain variation in TBA referral behavior across the maternal continuum, from the antenatal to postnatal period.ResultsDifferences in TBA referral before, during, and after delivery appear to reflect the TBAs understanding of the added value of skilled care for the client and the TBA, as well as the TBA’s perception of the implications of referral for her credibility as a maternal care provider among her clients. We also found that there are opportunities to engage TBAs in routine postnatal care referrals to facilities in Nigeria by using incentives and promoting a cordial relationship between TBAs and skilled health workers.ConclusionsThus, despite the potential negative consequences TBAs may face with postnatal care referrals, there are opportunities to promote these referrals using incentives and promoting a cordial relationship between TBAs and skilled health workers. Further research is needed on the interactions between postnatal maternal complications, TBA referral behavior, and maternal perception of TBA competence.

The gendered health workforce: mixed methods analysis from four fragile and post-conflict contexts.

It is well known that the health workforce composition is influenced by gender relations. However, little research has been done which examines the experiences of health workers through a gender lens, especially in fragile and post-conflict states. In these contexts, there may not only be opportunities to (re)shape occupational norms and responsibilities in the light of challenges in the health workforce, but also threats that put pressure on resources and undermine gender balance, diversity and gender responsive human resources for health (HRH). We present mixed method research on HRH in four fragile and post-conflict contexts (Sierra Leone, Zimbabwe, northern Uganda and Cambodia) with different histories to understand how gender influences the health workforce. We apply a gender analysis framework to explore access to resources, occupations, values, decision-making and power. We draw largely on life histories with male and female health workers to explore their lived experiences, but complement the analysis with evidence from surveys, document reviews, key informant interviews, human resource data and stakeholder mapping. Our findings shed light on patterns of employment: in all contexts women predominate in nursing and midwifery cadres, are under-represented in management positions and are clustered in lower paying positions. Gendered power relations shaped by caring responsibilities at the household level, affect attitudes to rural deployment and women in all contexts face challenges in accessing both pre- and in-service training. Coping strategies within conflict emerged as a key theme, with experiences here shaped by gender, poverty and household structure. Most HRH regulatory frameworks did not sufficiently address gender concerns. Unless these are proactively addressed post-crisis, health workforces will remain too few, poorly distributed and unable to meet the health needs of vulnerable populations. Practical steps need to be taken to identify gender barriers proactively and engage staff and communities on best approaches for change.

Physical activity and calorie intake mediate the relationship from depression to body fat mass among female Mexican health workers

BackgroundDepression is a foremost cause of morbidity throughout the world and the prevalence of depression in women is about twice as high as men. Additionally, overweight and obesity are major global health concerns. We explored the relationship between depression and body fat, and the role of physical activity and diet as mediators of this relationship in a sample of 456 adult female Mexican health workers.MethodLongitudinal and cross-sectional analyses using data from adult women of the Health Workers Cohort Study (HWCS) Measures of body fat mass (kg from DEXA), dietary intake (kcal from FFQ), leisure time activity (METs/wk) and depression (CES-D) were determined in two waves (2004–2006 and 2010–2011). We explored the interrelation between body fat, diet, leisure time, physical activity, and depression using a cross-lagged effects model fitted to longitudinal data. We also fitted a structural equations model to cross-sectional data with body fat as the main outcome, and dietary intake and physical activity from leisure time as mediators between depression and body fat.ResultsBaseline depression was significantly related to higher depression, higher calorie intake, and lower leisure time physical activity at follow-up. From our cross-sectional model, each standard deviation increase in the depression score was associated with an average increase of 751 ± 259 g (± standard error) in body fat through the mediating effects of calorie intake and physical activity.ConclusionsThe results of this study show how depression may influence energy imbalance between calories consumed and calories expended, resulting in higher body fat among those with a greater depression score. Evaluating the role of mental conditions like depression in dietary and physical activity behaviors should be positioned as a key research goal for better designed and targeted public health interventions.Trial registrationThe HealthWorkers Cohort Study (HWCS) has been approved by the Institutional IRB. Number: 2005–785-012.

Negotiating power relations, gender equality, and collective agency: are village health committees transformative social spaces in northern India?

BackgroundParticipatory health initiatives ideally support progressive social change and stronger collective agency for marginalized groups. However, this empowering potential is often limited by inequalities within communities and between communities and outside actors (i.e. government officials, policymakers). We examined how the participatory initiative of Village Health, Sanitation, and Nutrition Committees (VHSNCs) can enable and hinder the renegotiation of power in rural north India.MethodsOver 18 months, we conducted 74 interviews and 18 focus groups with VHSNC members (including female community health workers and local government officials), non-VHSNC community members, NGO staff, and higher-level functionaries. We observed 54 VHSNC-related events (such as trainings and meetings). Initial thematic network analysis supported further examination of power relations, gendered “social spaces,” and the “discourses of responsibility” that affected collective agency.ResultsVHSNCs supported some re-negotiation of intra-community inequalities, for example by enabling some women to speak in front of men and perform assertive public roles. However, the extent to which these new gender dynamics transformed relations beyond the VHSNC was limited. Furthermore, inequalities between the community and outside stakeholders were re-entrenched through a “discourse of responsibility”: The comparatively powerful outside stakeholders emphasized community responsibility for improving health without acknowledging or correcting barriers to effective VHSNC action. In response, some community members blamed peers for not taking up this responsibility, reinforcing a negative collective identity where participation was futile because no one would work for the greater good. Others resisted this discourse, arguing that the VHSNC alone was not responsible for taking action: Government must also intervene. This counter-narrative also positioned VHSNC participation as futile.ConclusionsInterventions to strengthen participation in health systems can engender social transformation. However they must consider how changing power relations can be sustained outside participatory spaces, and how discourse frames the rationale for community participation.

Experience of intimate partner violence among female health workers in South East Nigeria

ABSTRACTIntimate partner violence (IPV) is one of the most pervasive forms of violence against women with few studies documenting the magnitude of the problem among female health workers. This was a descriptive cross-sectional study of 392 female health workers. A pre-tested semi-structured self-administered questionnaire was used to collect data. Data were analysed using SPSS Version 15. About 56.6% of the health workers had a lifetime experience of abuse. Verbal (100%) and sexual abuse (71.7%) were the commonest forms of abuse. Most (85.5%) of those who had ever been abused justified it (X² = 86.5, p = .00, OR; 2.3; 1.9–2.7). Respondents >40 years (OR = 8.9, p = .00) and Protestants (X² = 9.1, p = .00, OR: 1.9; 1.3–2.9 had the highest likelihood of ever experiencing any form of abuse. Only 94 (46.8%) of the currently abused have ever complained about their experience. In view of the high level of justification of abuse, female health workers should be educated on IPV.

A study of factors affecting the knowledge of Janani Shishu Suraksha Karyakram among health workers in rural block Shirur of Pune district, Maharashtra

Background: Government of India launched the Janani Shishu Suraksha Karyakram (JSSK) on 1st June 2011, a new national initiative, to make better health facilities for women and child. The scheme is estimated to benefit more than 12 million pregnant women who access govt. health facilities for their delivery. The objective was to study the factors affecting the knowledge of Janani Shishu Suraksha Karyakram (JSSK) among health workers in rural block Shirur.Methods: A cross-sectional study was conducted among health workers in field practice area of rural block Shirur which is the rural field practice area of B J Government Medical College, Pune. It consists of 9 primary health centers and total 43 subcenters. A pilot study was conducted before initiating the study and the proforma was tested. The data was collected during the weekly meeting at primary health center. All the health workers were given prior information regarding the day of interview. The information regarding the knowledge of JSKK was recorded on the pre-structured and pre-tested proforma was recorded. The detail information regarding of the health workers, duration of service, educational status and training of JSSK etc. was recorded. Results: About 34.64% health workers were having excellent knowledge whereas 46.53% of health workers were having adequate knowledge of JSSK. The age distribution of health workers according to knowledge showed no statistically significant association with knowledge. Among the female health workers majority were having excellent and adequate knowledge and difference observed in knowledge was statistically significant. Among the ANM only one was having poor knowledge of JSSK. Out of 16 LHV, 10 were having excellent knowledge. Majority of the health workers with less than 10 years of service were having excellent and adequate knowledge. Excellent and adequate knowledge was statistically significantly associated with the training status of the health workers. Conclusions: Female health workers (ANM and LHV) were having better knowledge as compared to other health workers. The training status of health worker has impact on their knowledge of JSSK.

Sharing Histories\u2014a transformative learning/teaching method to empower community health workers to support health behavior change of mothers

BackgroundOne of the keys to improving health globally is promoting mothers’ adoption of healthy home practices for improved nutrition and illness prevention in the first 1000 days of life from conception. Customarily, mothers are taught health messages which, even if simplified, are hard to remember. The challenge is how to promote learning and behavior change of mothers more effectively in low-resource settings where access to health information is poor, educational levels are low, and traditional beliefs are strong.MethodsIn addressing that challenge, a new learning/teaching method called “Sharing Histories” is in development to improve the performance of female community health workers (CHWs) in promoting mothers’ behaviors for maternal, neonatal and child health (MNCH).ResultsThis method builds self-confidence and empowerment of CHWs in learning sessions that are built on guided sharing of their own memories of childbearing and child care. CHWs can later share histories with the mother, building her trust and empowerment to change. For professional primary health care staff who are not educators, Sharing Histories is simple to learn and use so that the method can be easily incorporated into government health systems and ongoing CHW programs.ConclusionsI present here the Sharing Histories method, describe how it differs from other social and behavior change methods, and discuss selected literature from psychology, communications, and neuroscience that helps to explain how and why this method works as a transformative tool to engage, teach, transform, and empower CHWs to be more effective change agents with other mothers in their communities, thereby contributing to the attainment of the Sustainable Development Goals.

Evaluating the comparative effectiveness of different demand side interventions to increase maternal health service utilization and practice of birth spacing in South Kivu, Democratic Republic of Congo: an innovative, mixed methods approach

BackgroundIn this protocol we describe a mixed methods study in the province of South Kivu, Democratic Republic of Congo evaluating the effectiveness of different demand side strategies to increase maternal health service utilization and the practice of birth spacing. Conditional service subsidization, conditional cash transfers and non-monetary incentives aim to encourage women to use maternal health services and practice birth spacing in two different health districts. Our methodology will comparatively evaluate the effectiveness of different approaches against each other and no intervention.Methods/designThis study comprises four main research activities: 1) Formative qualitative research to determine feasibility of planned activities and inform development of the quantitative survey; 2) A community-based, longitudinal survey; 3) A retrospective review of health facility records; 4) Qualitative exploration of intervention acceptability and emergent themes through in-depth interviews with program participants, non-participants, their partners and health providers. Female community health workers are engaged as core members of the research team, working in tandem with female survey teams to identify women in the community who meet eligibility criteria. Female community health workers also act as key informants and community entry points during methods design and qualitative exploration. Main study outcomes are completion of antenatal care, institutional delivery, practice of birth spacing, family planning uptake and intervention acceptability in the communities. Qualitative methods also explore decision making around maternal health service use, fertility preference and perceptions of family planning.DiscussionThe innovative mixed methods design allows quantitative data to inform the relationships and phenomena to be explored in qualitative collection. In turn, qualitative findings will be triangulated with quantitative findings. Inspired by the principles of grounded theory, qualitative analysis will begin while data collection is ongoing. This “conversation” between quantitative and qualitative data will result in a more holistic, context-specific exploration and understanding of research topics, including the mechanisms through which the interventions are or are not effective. In addition, engagement of female community health workers as core members of the research team roots research methods in the realities of the community and provides teams with key informants who are simultaneously implicated in the health system, community and target population.

How female community health workers navigate work challenges and why there are still gaps in their performance: a look at female community health workers in maternal and child health in two Indian districts through a reciprocal determinism framework

BackgroundAccredited Social Health Activists (ASHAs) are community health workers tasked to deliver health prevention in communities and link them with the health care sector. This paper examines the social, cultural, and institutional influences that either facilitate or impede ASHAs’ abilities to deliver services effectively through the lens of the reciprocal determinism framework of social cognitive theory.MethodsWe conducted 98 semi-structured, in-depth interviews with ASHAs (n = 49) and their family members (n = 49) in Gurdaspur and Mewat districts. Data were analyzed by comparing and contrasting codes leading to the identification of patterns which were explained with the help of a theoretical framework.ResultsWe found that while the work of ASHAs led to some positive health changes in the community, thus providing them with a sense of self-worth and motivation, community norms and beliefs as well as health system attitudes and practices limited their capacity as community health workers.ConclusionWe outline potential mechanisms for improving ASHA capacity such as improved sensitization about religious, cultural, and gender norms; enhanced communication skills; and sensitization and advocating their work with health and state officials.

EMOTIONAL INTELLIGENCE APTITUDE: AN ESSENTIAL PILLAR FOR HEALTH SERVICE PROVIDERS

Emotional Intelligence has a critical role to play in the rapid and fast changing services sector. The reason behind this huge transformation is changing attitudes and desires of consumers and enhanced level of competition in the market. Emotional Intelligence paradigms design and implement procedures and techniques through which we can access and manage our own emotions and emotions of others’ surrounding us. It has been believed till today that higher level of Emotional Intelligence helps in enhancing the productivity and efficiency level of workers at work place and even brings harmony in their social patterns. The present study seeks to access the level of Emotional Intelligence of health workers in Rajouri and Poonch districts of Jammu and Kashmir. The study also analyzes the Emotional Intelligence competencies of health workers and differences in emotional intelligence scores of males and females as well. The study further recommends strategies for enhancing the emotional quotient of male and female health workers. The results revealed that both male and female health workers possess some level of Emotional Intelligence score and Emotional Intelligence competence score. The emotional intelligence level of male and female health workers in Rajouri and Poonch districts also differ .

Knowledge about cervical cancer screening and its practice among female health care workers in southern Ethiopia: a cross-sectional study.

BackgroundCervical cancer remains a major cause of morbidity and mortality among the women in the world. Early screening for cervical cancer is a key intervention in reduction of maternal deaths. Health care workers have a significant contribution to improve cervical cancer screening practice among women. Hence, this study aimed to assess the knowledge and practice of cervical cancer screening among female health care workers in southern Ethiopia.MethodsInstitution-based cross-sectional study was conducted during March and April, 2015. All hospitals in Hawassa city administration and Sidama zone were purposively selected. A simple random sampling technique was used to draw the health centers. After proportional allocations to their respective health facilities, a total of 367 female health workers were selected by simple random sampling technique. A structured and pretested questionnaire was used to collect the data. Data were entered to SPSS version 20.0 for further analysis. Logistic regression analyses were used to see the association of different variables.ResultsOut of the total respondents, 319 (86.9%) had a good level of knowledge on cervical cancer. Similarly, a majority of them, 329 (89.6%), 321 (87.5%), and 295 (80.4%), knew about the risk factors, symptoms, and outcomes of cervical cancer, respectively. More than two thirds of the respondents, 283 (77.1%), knew that there is a procedure used to detect premalignant cervical lesions and 138 (37.6%) of them mentioned visual inspection with acetic acid as a screening method. In this study, only 42 (11.4%) of the respondents were screened for cervical cancer (confidence interval [CI]: 8.7, 13.9). Being a physician (adjusted odds ratio [AOR] =0.12, 95% CI: 0.02, 0.79) and working in a cervical cancer screening center (AOR =0.14, 95% CI: 0.03, 0.68) had a lower odds of cervical cancer screening practices.ConclusionsSignificant numbers of health care workers were knowledgeable on cervical cancer. Cervical cancer screening among health care workers in southern Ethiopia was found to be low. Being a physician and working in a screening center had lower odds of cervical cancer screening practice. In spite of having adequate knowledge on cervical cancer the reasons for low practice of cervical cancer screening among health care workers needs to be investigated.

Barriers to access in maternal healthcare services in the Northern Bangladesh

Poor women, in both rural and urban areas in the northern region of Bangladesh, experience high maternal mortality rate (MMR), and compared to other regions, this group also has a low proportion of receiving antenatal care (ANC) and of births assisted by the skilled health personnel. One of the prime factors for this situation is the lack of the poor mothers’ access to maternal health care (MHC) services. Finding out physical, social and organisational access barriers to MHC services and exploring how these barriers caused three delays in healthcare seeking behaviour were therefore the main objectives of the paper. The study used both primary and secondary data to meet its objectives. The primary data was collected from October to December in 2010 interviewing 160 mothers who were pregnant or delivered at least one baby during the last ten years and the heads of seven relevant health centres, administering eight focus group discussions and observing the field. An assortment of articles, reports, theses and books were consulted in complementing and substantiating the argument. The study found social (early marriage, perception of pregnancy and childbirth, high financial cost) and organizational (lack of female health staff, lack of a guiding principle in the health sector, in/exclusion errors in benefit distribution, low quality services) barriers more acute than physical (distance and waiting time) barriers. As concluded, all these barriers seem to have caused delays in seeking healthcare, reaching facility centres at the right time and receiving adequate services. The findings of the current study suggest that rescheduling official time of the service centre, recruiting and posting female health workers, following a guiding path and providing emergency obstetric care at free of costs are the feasible ways of getting better maternal health situation in the study areas.South East Asia Journal of Public Health Vol.6(2) 2016: 23-36