“If I Was Educated, I Would Call the Ambulance and Give Birth at the Health Facility”—A Qualitative Exploratory Study of Inequities in the Utilization of Maternal, Newborn, and Child Health Services in Northern Ethiopia

Alem Desta Wuneh (), Afework Mulugeta Bezabih, Lars Åke Persson, Yemisrach Behailu Okwaraji and Araya Abrha Medhanyie
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Alem Desta Wuneh: School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia
Afework Mulugeta Bezabih: School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia
Lars Åke Persson: Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
Yemisrach Behailu Okwaraji: Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
Araya Abrha Medhanyie: School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia

IJERPH, 2022, vol. 19, issue 18, 1-14

Abstract: In earlier studies, we have shown that the utilization of maternal health services in rural Ethiopia was distributed in a pro-rich fashion, while the coverage of child immunization was equitably distributed. Hence, this study aimed to explore mothers’ and primary healthcare workers’ perceptions of inequities in maternal, newborn, and child health services in rural Ethiopia, along with the factors that could influence such differentials. A qualitative study was conducted from November to December 2019 in two rural districts in Tigray, Ethiopia. Twenty-two in-depth interviews and three focus group discussions were carried out with mothers who had given birth during the last year before the survey. We also interviewed women’s development group leaders, health extension workers, and health workers. The final sample was determined based on the principle of saturation. The interviews and focus group discussions were audiotaped, transcribed, translated, coded, and analyzed using thematic analysis. Two major themes emerged during the analysis that characterized the distribution of the service utilization and perceived causes of inequity. These were: (1) perceptions of the inequity in the use of maternal and child health services, and (2) perceived causes of inequity in maternal and child health service utilization. The mothers perceived antenatal care, facility-based delivery, and care-seeking for sick children to be inequitably distributed, while immunization was recognized as an equitable service. The inequity in the maternal and child health services was linked to poverty, lack of education, lack of access, and poor-quality services. The poor, the uneducated, and women who were distant from health facilities had a low utilization rate of services. The weak implementation of community-based equity-oriented policies, such as community-based health insurance, was perceived to result in health inequities. Mothers and primary healthcare providers in rural Ethiopia experienced weaknesses in delivering equitable services. The narratives could inform efforts to provide universal health coverage for mothers, newborns, and children by improving access and empowering women through poverty alleviation and education.

Keywords: maternal and child health services; utilization; inequity; qualitative; Ethiopia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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