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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Stakeholders’ perspectives on facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea: a qualitative study

Authors: Chol Chol, Cynthia Hunter, Berhane Debru, Berhana Haile, Joel Negin, Robert G. Cumming

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

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Abstract

Background

Wars affect maternal health services by destroying health systems. Eritrea experienced two wars with neighbouring Ethiopia. Despite this, the maternal mortality ratio (MMR) in Eritrea fell by 69% from 1590 per 100,000 live births in 1990 to 501 in 2015. This study aimed to examine facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea.

Methods

Using in-depth interviews and field observations for data collection, this qualitative study was conducted in five healthcare facilities in Asmara, the capital of Eritrea, in February and March 2016. The participants were: women (n = 40), husbands (n = 5), healthcare providers (n = 10), and decision makers (n = 5).

Results

There were two perceived facilitators of utilisation of and access to maternal health services: health education (related to the WHO health service delivery building blocks) and improvement in gender equality driven by the role played by Eritrean women as combatants during the War of Independence (1961–1991). The only perceived barrier was poor quality of care due to lack of ultrasound machines, short clinic opening hours, and shortage of healthcare workers (related to the WHO health workforce building block).

Conclusion

This study assessed women and their husbands/partners’ perceptions and the possible effects of contemporary Eritrean culture and the history of war on the utilisation of and access to maternal health services in the country. As well, we examined healthcare providers’ and decision makers’ perspectives. The two key facilitators of women’s utilisation of and access to maternal health services were health education and women’s empowerment driven by their role as combatants during the War of Independence. One main barrier was poor quality of care due to lack of ultrasound machines, short clinic opening hours, and a shortage of healthcare workers. As only a limited number of qualitative studies have been published about maternal health services in war-affected sub-Saharan African countries, our findings regarding health education and women’s empowerment could be considered in other war-affected countries similar to Eritrea. Nevertheless, further research is needed to investigate our findings – particularly regarding female empowerment driven by women’s role in combat in relation to their maternal health.
Literature
1.
Garfield RM. War-related changes in health and health services in Nicaragua. Soc Sci Med. 1989;28(7):669–76.CrossRefPubMed
2.
Busza J, Lush L. Planning reproductive health in conflict: a conceptual framework. Soc Sci Med. 1999;49(2):155–71.CrossRefPubMed
3.
World Health Organization. The world health report 2000. Health systems: improving performance. Geneva: WHO; 2000.
4.
Price JI, Bohara AK. Maternal health care amid political unrest: the effect of armed conflict on antenatal care utilization in Nepal. Health Policy Plan. 2013;28(3):309.CrossRefPubMed
5.
Chi PC, Bulage P, Urdal H, Sundby J. Perceptions of the effects of armed conflict on maternal and reproductive health services and outcomes in Burundi and northern Uganda: a qualitative study. BMC Int Health Hum Rights. 2015;15(1):7.CrossRefPubMedPubMedCentral
6.
Strand H, Wilhelmsen L, Gleditsch N, International Peace Research Institute Oslo (PRIO). Armed conflict dataset codebook. Uppsala: PRIO; 2003.
7.
Themnér L, Wallensteen P. Armed conflicts, 1946–2011. J Peace Res. 2012;49(4):565–75.CrossRef
8.
WHO, UNICEF, UNFPA, The World Bank, United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Geneva: WHO; 2015.
9.
Murphy SD, editor The Eritrean-Ethiopian War (1998-2000). The Eritrean-Ethiopian war (1998–2000). George Washington University Legal Studies Conference. Washington, DC: Oxford University Press; 2016.
10.
Bernal V. Eritrea goes global: reflections on nationalism in a transnational era. Cult Anthropol. 2004;19(1):3–25.CrossRef
11.
World Health Organization. Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer. Geneva: WHO; 2004.
12.
The United Nations. Women's anti-discrimination committee takes-up report of Eritrea; told gender equality efforts hindered by stereotypes, poverty, war. New York: UN; 2006.
13.
The State of Eritrea Ministry of Health. Eritrea annual health service activity report of year 2012. Asmara: Eritrea Ministry of Health; 2013.
14.
UNDP. Innovations driving health MDGs in Eritrea. UNDP Eritrea: Asmara; 2014.
15.
The State of Eritrea Ministry of Health. National health policy. Asmara: Eritrea Ministry of Health; 2010.
16.
Holzgreve W, Greiner D, Schwidtal P. Maternal mortality in Eritrea: improvements associated with centralization of obstetric services. Int J Gynecol Obstet. 2012;119(SUPPL.1):S50–S4.CrossRef
17.
Sharan M, Ahmed S, Ghebrehiwet M, Rogo K. The quality of the maternal health system in Eritrea. Int J Gynaecol Obstet. 2011;115(3):244.CrossRefPubMed
18.
World Health Organization. World health statistics 2015. Geneva: WHO; 2015.
19.
The State of Eritrea Ministry of Health, ORC Macro. Eritrea Demographic and Health Survey 2002. Asmara: Eritrea Ministry of Health, Bureau of Statistics, and Calverton, MD, USA: ORC Macro; 2002.
20.
The State of Eritrea National Statistics Office (NSO), Fafo Institute for Applied International Studies (AIS). Eritrea Population and Health Survey 2010. Eritrea population and health survey 2010. Asmara: Eritrea Ministry of Health; 2013.
21.
Austin A, Fapohunda B, Langer A, Orobaton N. Trends in delivery with no one present in Nigeria between 2003 and 2013. Int J Womens Health. 2015;7:345–56.CrossRefPubMedPubMedCentral
22.
Mugo N, Dibley M, Agho K. Prevalence and risk factors for non-use of antenatal care visits: analysis of the 2010 South Sudan household survey. BMC Pregnancy Childbirth. 2015;15(1):68.
23.
The State of Eritrea Ministry of Health. Second national integrated monitoring and evaluation framework 2012–2016. Asmara: Eritrea Ministry of Health; 2012.
24.
Habtom GK, Ruys P. The choice of a health care provider in Eritrea. Health Policy. 2007;80(1):202–17.CrossRefPubMed
25.
Jennings L, Na M, Cherewick M, Hindin M, Mullany B, Ahmed S. Women’s empowerment and male involvement in antenatal care: analyses of demographic and health surveys (DHS) in selected African countries. BMC Pregnancy Childbirth. 2014;14(1):297.CrossRefPubMedPubMedCentral
26.
Bowling A. Research methods in health: investigating health and health services. Maidenhead: McGraw-Hill Education; 2014.
27.
World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva: WHO; 2010.
28.
29.
30.
Sidel V, Levy B. The health impact of war. Int J Inj Control Saf Promot. 2008;15(4):189–95.CrossRef
31.
32.
Chi PC, Bulage P, Urdal H, Sundby J. A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and northern Uganda. BMC Pregnancy Childbirth. 2015;15:18.CrossRefPubMedPubMedCentral
33.
34.
Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27(2):237–46.CrossRef
35.
El-Jardali F, Adam T, Ataya N, Jamal D, Jaafar M. Constraints to applying systems thinking concepts in health systems: a regional perspective from surveying stakeholders in eastern Mediterranean countries. Int J Health Policy Manage. 2014;3(7):399–407.CrossRef
36.
Miles MB, Huberman AM. Qualitative data analysis: a sourcebook of new methods. California: Sage Publications; 1984. Report No: 0803922744; 9780803922747
37.
Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117.CrossRefPubMedPubMedCentral
38.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
39.
Howard-Grabman L, Snetro G. How to mobilize communities for health and social change. Maryland: Management Science for Health; 2003.
40.
Rosato M, Laverack G, Grabman LH, Tripathy P, Nair N, Mwansambo C, et al. Community participation: lessons for maternal, newborn, and child health. Lancet. 2008;372(9642):962–71.CrossRefPubMed
41.
Turan JM, Tesfagiorghis M, Polan ML. Evaluation of a community intervention for promotion of safe motherhood in Eritrea. J Midwifery Womens Health. 2011;56(1):8–17.CrossRefPubMedPubMedCentral
42.
World Health Organization. Ottawa charter for health promotion. Geneva: WHO; 1986.
43.
Frenk J, Gómez-Dantés O, Langer A. A comprehensive approach to women's health: lessons from the Mexican health reform. BMC Womens Health. 2012;12(1):42.CrossRefPubMedPubMedCentral
44.
Singh K, Bloom S, Brodish P. Gender equality as a means to improve maternal and child health in Africa. Health Care Women Int. 2015;36(1):57–69.CrossRefPubMed
45.
The United Nations. Implementation of the Beijing platform for action and the outcome douments of the twenty-third special session of the general assembly. New York: UN; 2004.
46.
Elborgh-Woytek K, Newiak M, Kochhar K, Fabrizio S, Kpodar K, Wingender P, et al. Women, work, and the economy: macroeconomic gains from gender equity. IMF Staff Discussion. Washington DC: IMF; 2010.
47.
The World Bank. Labor force participation rate. Washington DC: World Bank; 2016.
48.
Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry. 1988;25(1):25–36.PubMed
Metadata
Title
Stakeholders’ perspectives on facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea: a qualitative study
Authors
Chol Chol
Cynthia Hunter
Berhane Debru
Berhana Haile
Joel Negin
Robert G. Cumming
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1665-9

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