Menu
Menu
Menu
Menu
Globally, 298,000 women die due to pregnancy related causes and half of this occurs in Africa. In Uganda, maternal mortality has marginally reduced from 526 to 336 per 100,000 live births between 2001 and 2016. Health facility delivery is an important factor in improving maternal and neonatal outcomes. However, the concept of using a skilled birth attendant is not popular in Uganda. An earlier intervention to mobilize communities in the Masindi region for maternal and newborn health services discovered that immigrant populations used maternal health services less compared to the indigenous populations. The aim of this qualitative study was therefore to better understand why immigrant populations were using maternal health services less and what the barriers were in order to suggest interventions that can foster equitable access to maternal health services. Five focus group discussions (FGDs) (three among women; 2 with men), 8 in-depth interviews with women, and 7 key informant interviews with health workers were used to better understand the experiences of immigrants with maternal and newborn services. Interviews and FGDs were conducted from July to September 2016. Data were analyzed using content analysis and intersectionality. Results were based on the following thematic areas: perceived discrimination based on ethnicity as a barrier to access, income, education and gender. Immigrant populations perceived they were discriminated against because they could not communicate in the local dialect, they were poor casual laborers, and/or were not well schooled. Matters of pregnancy and childbearing were considered to be matters for women only, while financial and other decisions at the households are a monopoly of men. The silent endurance of labor pains was considered a heroic action. In contrast, care-seeking early during the onset of labor pains attracted ridicule and was considered frivolous. In this context, perceived discrimination, conflicting gender roles, and societal rewards for silent endurance of labor pains intersect to create a unique state of vulnerability, causing a barrier to access to maternal and newborn care among immigrant women. We recommend platforms to demystify harmful cultural norms and training of health workers on respectful treatment based on the 12 steps to safe and respectful mother baby-family care.
Study site: The study was conducted in Nyantonzi parish in Masindi district. This parish was purposively selected because it had the highest density of immigrant population. In Uganda, a parish is a geographical area with a population of approximately 10,000 to 20,000 inhabitants. Nyantonzi parish has a population of approximately 15,300 inhabitants, accounting for 4% of the total population of Masindi district. Masindi district consists of 27 parishes, with a total population of 391,900 inhabitants. The local inhabitants of Masindi are predominantly Banyoro, which belong to the large ethnic group known as the Bantu, and they speak the Runyoro dialect. Immigrant populations come mainly from the West Nile districts of Nebbi and Arua, and they belong to the Sudanic Ma’di ethnic group. Immigrant populations are essentially economic immigrants seeking job opportunities within the sugarcane plantations of Kinyala Sugar. The Bantu and Sudanic Ma’di dialects are completely unrelated. In Masindi district, about 35% of women attend 4 antenatal visits and 30% deliver in a health facility, compared to the national average of 57%.[19] Neonatal mortality in the western region of Uganda is 30/1000 live births compared to the national average of 27/1000 live births.[20] Data collection: Data were collected through focus group discussions (FGDs), in-depth interviews, and key informant interviews. Five FGDs with immigrant men and women (three with women and 2 with men) were conducted, with each group having 8 participants. Two of the FGDs were conducted with women who had recently delivered and 1 was conducted with pregnant women. The FGDs with men included 1 group whose spouses were pregnant and 1 group whose spouses had recently delivered. All groups were selected based on their Lugbara immigrant status. Focus group discussion questions related to perceived barriers to accessing care at the health facility, experiences of care in health facilities (health centers and hospitals), reasons for negative health facility experiences, gender relations at the household level, and suggestions for improving access to and utilization of maternal health care. In-depth interviews were conducted with lactating women who had experience interacting with the health system during pregnancy or labor. Key informant interviews were conducted with health workers at the referral hospital and 2 health centers in Nyantonzi parish. All interviews lasted approximately 45–60 minutes. Interviews were conducted until saturation was reached. All interviews were conducted by 2 female social science researchers. One researcher was a gender expert and doctoral student from the school of gender studies at Makerere University, while a second researcher was well versed with the local dialect commonly spoken among the immigrant population. Both researchers were trained on the objectives of the study and were oriented to the question guide. Data analysis: FGDs and in-depth interviews were audiotaped, and translation was performed during interview transcription. Key informant interviews with health workers were conducted and transcribed in English. Thematic analysis was conducted. The first and second authors read the scripts several times and exported them to NVivo software for analysis. Data were coded based on a coding framework which mirrored the themes discussed during the interviews and included intersectional considerations. From the initial codes, texts with similar meaning were grouped together from which subthemes were developed, and subsequently meaningful thematic narrations were developed. This study was approved by the Higher Degrees Research and Ethics Committee of the School of Public Health, HDREC no. 324. Verbal consent to participate in the study was obtained from each study participant. The results of the study were reported to ensure anonymity.
N/A
