Why women in urban settings fail to use available maternal health services: Qualitative study in urban areas of Ethiopia

Background: Ethiopia is one of the countries with high maternal death across the world. Among others such high maternal morbidity is attributed to limited turn out to use antenatal care (ANC), delivery and postnatal care... [ view full abstract ]

Background: Ethiopia is one of the countries with high maternal death across the world. Among others such high maternal morbidity is attributed to limited turn out to use antenatal care (ANC), delivery and postnatal care services. Even in urban centers, where health service coverage is expected to be relatively better, still women are not using ANC, institutional delivery is postpartum care (PNC) attendance is low. This study aims to identify reasons why urban women fail to use such services in purposively selected towns.

Methods: We conducted eleven Focus Group Discussions with selected community members, 40 in-depth-interviews with stakeholders and 15 case studies with residents of selected urban quarters that are characterized as slums. Interviews were transcribed, read and themes were developed following the study objectives. Findings from the different groups were triangulated and interpreted.

Result: Study participants anonymously argued that there are positive changes in maternal health service utilization since Urban Health Extension Program started operating in urban settings. Yet, students, daily laborers, widows, divorced, separated, commercial sex workers, house maids, migrants and those who are worried about their HIV sero-status were usually reluctant to use ANC services, deliver at health facilities and attend PNC. Reasons were categorized under individual characteristics, perceived institutional capacities and friendliness of service providers and socio-cultural factors including socially sanctioned expectations.

Conclusion: Although service utilization in urban setting is relatively better, coverage of maternal health service is far from reality. This study shows that blanket programmatic approach should give way to intervention targeting specific section of population. Furthermore, programs are expected to address individual, institutional and socio-cultural factors in tandem to improve maternal health service utilization in urban setting.

Keywords: maternal health, urban health, Ethiopia