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Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

Women’s views and experiences of antenatal care in Iraq: a Q methodology study

Authors: Nazar P Shabila, Hamdia M Ahmed, Maryam Y Yasin

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

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Abstract

Background

Understanding women’s experiences and perspectives of antenatal care services is particularly critical for enhancing effectiveness of services delivery and addressing women’s needs and expectations. As part of a comprehensive assessment of the maternity care services in Iraq, this study aimed to explore the views and experiences of antenatal care in a sample of women.

Methods

This explorative study was conducted in Erbil governorate, Iraq. Data were collected using Q methodology, a technique for eliciting subjective views and identifying shared patterns among individuals. A sample of 38 women of different educational and socioeconomic statuses were invited to sort a set of 39 statements reflecting different aspects of the available antenatal care services and issues related to their last pregnancies into a distribution on a scale of nine from “disagree most” to “agree most”. By-person factor analysis was used to derive latent views through centroid factor extraction and varimax rotation of factors.

Results

Analysis of the participants’ Q sorts resulted in identifying four distinct views and experiences of pregnancy and antenatal care services: (i) public maternity services second best: preference for, and ability to afford, private care, (ii) dissatisfaction with public maternity services: poor information sharing and lack of health promotion, (iii) satisfaction with public maternity service but information gaps perceived and (iv) public maternity services second best: preference for private care but unaffordable. The typical characterizations that were associated with each view were highlighted.

Conclusions

This study revealed different patterns of views and experiences of women of pregnancy and antenatal care services and recognized the particular issues related to each pattern. Different patterns and types of problems and concerns related mainly to inadequate provision of information and poor interpersonal communication, poor utilization of public services and a general preference to use private services were identified in the different groups of women.
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Literature
2.
go back to reference WHO: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and the World Bank estimates. 2012, Geneva: WHO WHO: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and the World Bank estimates. 2012, Geneva: WHO
3.
go back to reference You D, New JR, Wardlaw T: Levels and trends in child mortality: Report 2012. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. 2012, New York: UNICEF You D, New JR, Wardlaw T: Levels and trends in child mortality: Report 2012. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. 2012, New York: UNICEF
4.
go back to reference Webster PC: Roots of Iraq’s maternal and child health crisis run deep. Lancet. 2013, 831: 892-894. Webster PC: Roots of Iraq’s maternal and child health crisis run deep. Lancet. 2013, 831: 892-894.
5.
go back to reference MOH WHO: UNICEF, UNFPA, WFP: Maternal and child health and reproductive health strategy in Iraq 2005-2008. 2005, Baghdad: Ministry of Health MOH WHO: UNICEF, UNFPA, WFP: Maternal and child health and reproductive health strategy in Iraq 2005-2008. 2005, Baghdad: Ministry of Health
6.
go back to reference Alwan A: Health in Iraq: The current situation, our vision for the future and areas of work. 2004, Baghdad: Ministry of Health, 2 Alwan A: Health in Iraq: The current situation, our vision for the future and areas of work. 2004, Baghdad: Ministry of Health, 2
7.
go back to reference Ali MM, Shah IH: Sanctions and childhood mortality in Iraq. Lancet. 2000, 355 (9218): 1851-1857. 10.1016/S0140-6736(00)02289-3.CrossRefPubMed Ali MM, Shah IH: Sanctions and childhood mortality in Iraq. Lancet. 2000, 355 (9218): 1851-1857. 10.1016/S0140-6736(00)02289-3.CrossRefPubMed
8.
go back to reference Alwan A: Health-sector funding: options for funding health care in Iraq. East Mediterr Health J. 2008, 14 (6): 1372-1379.PubMed Alwan A: Health-sector funding: options for funding health care in Iraq. East Mediterr Health J. 2008, 14 (6): 1372-1379.PubMed
9.
go back to reference WHO: Iraq Health System Profile. 2006, Cairo: EMRO WHO: Iraq Health System Profile. 2006, Cairo: EMRO
10.
go back to reference UNFPA: Iraq: Reproductive health assessment. 2003, Baghdad: UNFPA UNFPA: Iraq: Reproductive health assessment. 2003, Baghdad: UNFPA
11.
go back to reference Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp E, Vaughan K: Iraqi primary care system in Kurdistan region: providers’ perspectives on problems and opportunities for improvement. BMC Int Health Hum Rights. 2012, 12: 21-10.1186/1472-698X-12-21.CrossRefPubMedPubMedCentral Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp E, Vaughan K: Iraqi primary care system in Kurdistan region: providers’ perspectives on problems and opportunities for improvement. BMC Int Health Hum Rights. 2012, 12: 21-10.1186/1472-698X-12-21.CrossRefPubMedPubMedCentral
12.
go back to reference Raoof AM, Al-Hadithi TS: Antenatal care in Erbil city-Iraq: assessment of information, education and communication strategy. DMJ. 2011, 5 (1): 31-40. Raoof AM, Al-Hadithi TS: Antenatal care in Erbil city-Iraq: assessment of information, education and communication strategy. DMJ. 2011, 5 (1): 31-40.
13.
go back to reference Quinn J: Letter from the field: health security in Kurdistan. Journal of Human Security. 2011, 7 (2): 47-53. 10.3316/JHS0702047.CrossRef Quinn J: Letter from the field: health security in Kurdistan. Journal of Human Security. 2011, 7 (2): 47-53. 10.3316/JHS0702047.CrossRef
14.
go back to reference Wheatley RR, Kelley MA, Peacock N, Delgado J: Women’s narratives on quality in prenatal care: a multicultural perspective. Qual Health Res. 2008, 18 (11): 1586-1598. 10.1177/1049732308324986.CrossRefPubMed Wheatley RR, Kelley MA, Peacock N, Delgado J: Women’s narratives on quality in prenatal care: a multicultural perspective. Qual Health Res. 2008, 18 (11): 1586-1598. 10.1177/1049732308324986.CrossRefPubMed
15.
go back to reference Sword W, Heaman MI, Brooks S, Tough S, Janssen PA, Young D, Kingston D, Helewa ME, Akhtar-Danesh N, Hutton E: Women’s and care providers’ perspectives of quality prenatal care: a qualitative descriptive study. BMC Pregnancy Childbirth. 2012, 12: 29-10.1186/1471-2393-12-29.CrossRefPubMedPubMedCentral Sword W, Heaman MI, Brooks S, Tough S, Janssen PA, Young D, Kingston D, Helewa ME, Akhtar-Danesh N, Hutton E: Women’s and care providers’ perspectives of quality prenatal care: a qualitative descriptive study. BMC Pregnancy Childbirth. 2012, 12: 29-10.1186/1471-2393-12-29.CrossRefPubMedPubMedCentral
16.
go back to reference Chinnis AS, Summer DE, Doerr C, Paulson DJ, Davis SM: Q-Methodology: a new way of assessing employee satisfaction. J Nurs Adm. 2001, 31 (5): 252-259.CrossRefPubMed Chinnis AS, Summer DE, Doerr C, Paulson DJ, Davis SM: Q-Methodology: a new way of assessing employee satisfaction. J Nurs Adm. 2001, 31 (5): 252-259.CrossRefPubMed
17.
go back to reference Davis CH, Michelle C: Q methodology in audience research: bridging the qualitative/quantitative ‘divide’?. Participations: Journal of Audience and Reception Studies. 2011, 8 (2): 559-593. Davis CH, Michelle C: Q methodology in audience research: bridging the qualitative/quantitative ‘divide’?. Participations: Journal of Audience and Reception Studies. 2011, 8 (2): 559-593.
18.
go back to reference Brown SR: Q Methodology. The SAGE Encyclopedia of Qualitative Research Methods. Edited by: Given LM. 2008, Thousand Oaks, CA: Sage, Brown SR: Q Methodology. The SAGE Encyclopedia of Qualitative Research Methods. Edited by: Given LM. 2008, Thousand Oaks, CA: Sage,
19.
go back to reference Karim K: Q methodology-advantages and the disadvantages of this research method. J Community Nurs. 2001, 15 (4): 8-10. Karim K: Q methodology-advantages and the disadvantages of this research method. J Community Nurs. 2001, 15 (4): 8-10.
21.
go back to reference Smith NW: Current systems in psychology: history, theory, research, and applications. 2001, Belmont, CA: Wadsworth Smith NW: Current systems in psychology: history, theory, research, and applications. 2001, Belmont, CA: Wadsworth
22.
go back to reference Perz J, Ussher JM, Gilbert E: Constructions of sex and intimacy after cancer: Q methodology study of people with cancer, their partners, and health professionals. BMC Cancer. 2013, 13: 270-10.1186/1471-2407-13-270.CrossRefPubMedPubMedCentral Perz J, Ussher JM, Gilbert E: Constructions of sex and intimacy after cancer: Q methodology study of people with cancer, their partners, and health professionals. BMC Cancer. 2013, 13: 270-10.1186/1471-2407-13-270.CrossRefPubMedPubMedCentral
23.
go back to reference Cross-Sudworth F, Williams A, Herron-Marx S: Maternity services in multi-cultural Britain: using Q methodology to explore the views of first- and second-generation women of Pakistani origin. Midwifery. 2011, 27 (4): 458-468. 10.1016/j.midw.2010.03.001.CrossRefPubMed Cross-Sudworth F, Williams A, Herron-Marx S: Maternity services in multi-cultural Britain: using Q methodology to explore the views of first- and second-generation women of Pakistani origin. Midwifery. 2011, 27 (4): 458-468. 10.1016/j.midw.2010.03.001.CrossRefPubMed
24.
go back to reference Watts S, Stenner P: Doing Q methodological research: Theory, method and interpretation. 2012, London: SAGE Publications LtdCrossRef Watts S, Stenner P: Doing Q methodological research: Theory, method and interpretation. 2012, London: SAGE Publications LtdCrossRef
25.
go back to reference Donabedian A: The quality of care: how can it be assessed?. JAMA. 1988, 260 (12): 1743-1748. 10.1001/jama.1988.03410120089033.CrossRefPubMed Donabedian A: The quality of care: how can it be assessed?. JAMA. 1988, 260 (12): 1743-1748. 10.1001/jama.1988.03410120089033.CrossRefPubMed
28.
30.
go back to reference Brown SR: Political subjectivity: Applications of Q methodology in political science. 1980, New Haven, CT: Yale University Press Brown SR: Political subjectivity: Applications of Q methodology in political science. 1980, New Haven, CT: Yale University Press
31.
go back to reference Watts S, Stenner P: Doing Q methodology: theory, method and interpretation. Qual Res Psychol. 2005, 2: 67-91. 10.1191/1478088705qp022oa.CrossRef Watts S, Stenner P: Doing Q methodology: theory, method and interpretation. Qual Res Psychol. 2005, 2: 67-91. 10.1191/1478088705qp022oa.CrossRef
32.
go back to reference Stainton Rogers R: Q methodology. Rethinking methods in psychology. Edited by: Smith JA, Harre R, Van Langenhove L. 1995, Thousand Oaks, CA: Sage, 178-192.CrossRef Stainton Rogers R: Q methodology. Rethinking methods in psychology. Edited by: Smith JA, Harre R, Van Langenhove L. 1995, Thousand Oaks, CA: Sage, 178-192.CrossRef
33.
go back to reference Shinebourne P: Using Q method in qualitative research. IJQM. 2009, 8 (1): 93-97. Shinebourne P: Using Q method in qualitative research. IJQM. 2009, 8 (1): 93-97.
34.
go back to reference Donner JC: Using Q-sorts in participatory processes: an introduction to the methodology. Social analysis: Selected tools and techniques. Edited by: Bank TSDFW. 2001, Washington, D.C: The World Bank Social Development Department, 24-59. Donner JC: Using Q-sorts in participatory processes: an introduction to the methodology. Social analysis: Selected tools and techniques. Edited by: Bank TSDFW. 2001, Washington, D.C: The World Bank Social Development Department, 24-59.
35.
go back to reference Hausmann-Muela S, Ribera JM, Nyamongo I: Health-seeking behaviour and the health system response. Disease Control Priority Project Working Paper No. 14. 2003, London: London School of Hygiene & Tropical Medicine Hausmann-Muela S, Ribera JM, Nyamongo I: Health-seeking behaviour and the health system response. Disease Control Priority Project Working Paper No. 14. 2003, London: London School of Hygiene & Tropical Medicine
36.
go back to reference Burnham G, Hoe C, Hung YW, Ferati A, Dyer A, Al Hifi T, Aboud R, Hasoon T: Perceptions and utilization of primary health care services in Iraq: findings from a national household survey. BMC Int Health Hum Rights. 2011, 11: 15-10.1186/1472-698X-11-15.CrossRefPubMedPubMedCentral Burnham G, Hoe C, Hung YW, Ferati A, Dyer A, Al Hifi T, Aboud R, Hasoon T: Perceptions and utilization of primary health care services in Iraq: findings from a national household survey. BMC Int Health Hum Rights. 2011, 11: 15-10.1186/1472-698X-11-15.CrossRefPubMedPubMedCentral
37.
go back to reference Abou-Zahr C, Wardlaw T: Antenatal care in developing countries: promises, achievements and missed opportunities: an analysis of trends, levels and differentials, 1990–2001. 2003, Geneva: WHO Abou-Zahr C, Wardlaw T: Antenatal care in developing countries: promises, achievements and missed opportunities: an analysis of trends, levels and differentials, 1990–2001. 2003, Geneva: WHO
38.
go back to reference Hamdy NA: MSc thesis. Improving health education programs delivered by Duhok Directorate General of Health. 2010, Iraq: University of Duhok, College of Medicine Hamdy NA: MSc thesis. Improving health education programs delivered by Duhok Directorate General of Health. 2010, Iraq: University of Duhok, College of Medicine
39.
go back to reference Bjerregaard D: Quality assurance in the Jordan primary health care system: Best practices. 2004, Primary Health Care Initiatives: Amman Bjerregaard D: Quality assurance in the Jordan primary health care system: Best practices. 2004, Primary Health Care Initiatives: Amman
40.
go back to reference Sohrabi MR, Albalushi RM: Clients’ satisfaction with primary health care in Tehran: a cross-sectional study on Iranian Health Centers. J Res Med Sci. 2011, 16 (6): 756-762.PubMedPubMedCentral Sohrabi MR, Albalushi RM: Clients’ satisfaction with primary health care in Tehran: a cross-sectional study on Iranian Health Centers. J Res Med Sci. 2011, 16 (6): 756-762.PubMedPubMedCentral
41.
go back to reference Montasser NAE, Helal RM, Megahed WM, Amin SK, Saad AM, Ibrahim TR, Abd Elmoneem HM: Egyptian women’s satisfaction and perception of antenatal care. International Journal of TROPICAL DISEASE & Health. 2012, 2 (2): 145-156.CrossRef Montasser NAE, Helal RM, Megahed WM, Amin SK, Saad AM, Ibrahim TR, Abd Elmoneem HM: Egyptian women’s satisfaction and perception of antenatal care. International Journal of TROPICAL DISEASE & Health. 2012, 2 (2): 145-156.CrossRef
42.
go back to reference Abdal Qader MA, Badilla I, Mohd Amin R, Ghazi HF: Influence of antenatal care on birth weight: a cross sectional study in Baghdad City Iraq. BMC Public Health. 2012, 12 (Suppl 2): A38-10.1186/1471-2458-12-S2-A38.CrossRefPubMedCentral Abdal Qader MA, Badilla I, Mohd Amin R, Ghazi HF: Influence of antenatal care on birth weight: a cross sectional study in Baghdad City Iraq. BMC Public Health. 2012, 12 (Suppl 2): A38-10.1186/1471-2458-12-S2-A38.CrossRefPubMedCentral
43.
go back to reference Exavery A, Kanté AM, Hingora A, Mbaruku G, Pemba S, Phillips JF: How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania. BMC Pregnancy Childbirth. 2013, 13: 35-10.1186/1471-2393-13-35.CrossRefPubMedPubMedCentral Exavery A, Kanté AM, Hingora A, Mbaruku G, Pemba S, Phillips JF: How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania. BMC Pregnancy Childbirth. 2013, 13: 35-10.1186/1471-2393-13-35.CrossRefPubMedPubMedCentral
44.
go back to reference Eggleston E: Unintended pregnancy and women’s use of prenatal care in Ecuador. Soc Sci Med. 2000, 51 (7): 1011-1018. 10.1016/S0277-9536(00)00010-1.CrossRefPubMed Eggleston E: Unintended pregnancy and women’s use of prenatal care in Ecuador. Soc Sci Med. 2000, 51 (7): 1011-1018. 10.1016/S0277-9536(00)00010-1.CrossRefPubMed
45.
go back to reference Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp E: A qualitative assessment of the Iraqi primary health care system. World Health & Population. 2012, 13 (3): 18-27. 10.12927/whp.2012.22817.CrossRef Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp E: A qualitative assessment of the Iraqi primary health care system. World Health & Population. 2012, 13 (3): 18-27. 10.12927/whp.2012.22817.CrossRef
46.
go back to reference WHO: Iraq health system profile. 2005, Cairo: EMRO WHO: Iraq health system profile. 2005, Cairo: EMRO
47.
go back to reference Hansen PM, Peters DH, Edward A, Gupta S, Arur A, Niayesh H, Burnham G: Determinants of primary care service quality in Afghanistan. Int J Qual Health Care. 2008, 20 (6): 375-383. 10.1093/intqhc/mzn039.CrossRefPubMed Hansen PM, Peters DH, Edward A, Gupta S, Arur A, Niayesh H, Burnham G: Determinants of primary care service quality in Afghanistan. Int J Qual Health Care. 2008, 20 (6): 375-383. 10.1093/intqhc/mzn039.CrossRefPubMed
48.
go back to reference Uzochukwu BSC, Onwujekwe OE, Akpala CO: Community satisfaction with the quality of maternal and child health services in Southern Nigeria. East Afr Med J. 2004, 81 (6): 293-299.CrossRefPubMed Uzochukwu BSC, Onwujekwe OE, Akpala CO: Community satisfaction with the quality of maternal and child health services in Southern Nigeria. East Afr Med J. 2004, 81 (6): 293-299.CrossRefPubMed
49.
go back to reference WHO: Antenatal care in developing countries. Promises, achievements and missed opportunities: An analysis of trends, levels and differentials, 1990-2001. 2003, Geneva: WHO WHO: Antenatal care in developing countries. Promises, achievements and missed opportunities: An analysis of trends, levels and differentials, 1990-2001. 2003, Geneva: WHO
50.
go back to reference Grundy J, Annear P: Health-seeking behaviour studies: a literature review of study design and methods with a focus on Cambodia. Health Policy and Health Finance Knowledge Hub Working Paper Series No. 7. 2010, Melbourne, Australia: The Nossal Institute for Global Health Grundy J, Annear P: Health-seeking behaviour studies: a literature review of study design and methods with a focus on Cambodia. Health Policy and Health Finance Knowledge Hub Working Paper Series No. 7. 2010, Melbourne, Australia: The Nossal Institute for Global Health
51.
go back to reference Dennis KE, Goldberg AP: Weight control self-efficacy types and transitions affect weight-loss outcomes in obese women. Addict Behav. 1996, 21 (1): 103-116.CrossRefPubMed Dennis KE, Goldberg AP: Weight control self-efficacy types and transitions affect weight-loss outcomes in obese women. Addict Behav. 1996, 21 (1): 103-116.CrossRefPubMed
52.
go back to reference Baker R, van Exel J, Mason H, Stricklin M: Connecting Q and surveys: three methods to explore factor membership in large samples. Operant Subjectivity. 2010, 34 (1): 38-58. Baker R, van Exel J, Mason H, Stricklin M: Connecting Q and surveys: three methods to explore factor membership in large samples. Operant Subjectivity. 2010, 34 (1): 38-58.
53.
go back to reference Al-Atrushi HH, Al-Tawil NG, Shabila NP, Al-Hadithi TS: Intimate partner violence against women in the Erbil city of the Kurdistan region Iraq. BMC Womens Health. 2013, 13: 37-10.1186/1472-6874-13-37.CrossRefPubMedPubMedCentral Al-Atrushi HH, Al-Tawil NG, Shabila NP, Al-Hadithi TS: Intimate partner violence against women in the Erbil city of the Kurdistan region Iraq. BMC Womens Health. 2013, 13: 37-10.1186/1472-6874-13-37.CrossRefPubMedPubMedCentral
54.
go back to reference Al-Tawil NG: Association of violence against women with religion and culture in Erbil Iraq: a cross-sectional study. BMC Public Health. 2012, 12: 800-10.1186/1471-2458-12-800.CrossRefPubMedPubMedCentral Al-Tawil NG: Association of violence against women with religion and culture in Erbil Iraq: a cross-sectional study. BMC Public Health. 2012, 12: 800-10.1186/1471-2458-12-800.CrossRefPubMedPubMedCentral
Metadata
Title
Women’s views and experiences of antenatal care in Iraq: a Q methodology study
Authors
Nazar P Shabila
Hamdia M Ahmed
Maryam Y Yasin
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-14-43

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