Patient-identified barriers and facilitators to maternal health care in lmics: a qualitative study in Argentina and Ethiopia

Abstract

Ninety-nine percent of global maternity deaths occur in low-and-middle-income countries (LMICs), despite availability of high quality evidence-based guidelines for common causes of maternal mortality. An understanding of barriers and facilitators (BFs) to accessing and receiving evidence-based maternal care from the patients' perspective is lacking in the literature. We aimed to address this gap by assessing BFs to accessing and receiving evidence-based maternal care from the patients' perspective in two LMICs, Argentina and Ethiopia. We employed a multi-center qualitative design including 58 interviews and eight focus groups with reproductive age women and their families in Argentina and Ethiopia. Interview and focus group data were analyzed using a framework approach to content analysis. At the patient/community level, participants at both sites identified lack of knowledge as a barrier, and community belief in maternal care as a facilitator to women accessing and receiving care. Cultural beliefs, gender roles and decision making were identified as barriers and community funding to help with healthcare costs and education targeting husbands as facilitators, only in Ethiopia. At the provider level, mistreatment by providers was identified as a barrier in both sites, with mistrust of providers and preference for male providers barriers in Ethiopia only. Trust in providers was identified as a facilitator in Argentina, and local maternal health champions and providers from the local community facilitators in Ethiopia. Lack of coordination of care and transportation, and health care worker shortages, were identified as health system level barriers in both sites, and financial constraints noted only in Ethiopia. System level facilitators included patient education groups and use of social media in Argentina, and increased rural health centers and better organization of care, in Ethiopia. While the BFs identified by our participants are similar to those found in studies conducted with providers, our findings add to the literature by providing the unique perspectives of patients' and their families. In addition, variability in how specific BFs were experienced by patients/ families, highlights the importance of understanding context specific BF to allow for tailoring implementation strategies. Open Science Framework https://osf.io/xmjf7 Registered June 4, 2022.