Menu
Menu
Menu
Menu
Objective: Continuum of care (CoC) in maternal health is built on evidence suggesting that the integration of effective interventions across pregnancy, childbirth, and the postnatal period leads to better perinatal health outcomes. We explored gaps along the CoC in maternal health in Benin. Methods: A mixed-methods study triangulating results from a qualitative study in southern Benin with a quantitative analysis of Benin Demographic and Health Survey (BDHS) data on the use of services along the CoC was conducted. Results: Benin Demographic and Health Survey analysis showed that although 89% of women reported at least one antenatal care (ANC) visit, only half initiated ANC in the first trimester and completed 4 or more visits. 85% reported facility-based childbirth and 69% a postnatal check within 48 h after childbirth. Our qualitative study confirms early initiation of ANC and the transition from facility-based childbirth to postnatal care are important gaps along the CoC and reveals late arrival at health facility for childbirth as an additional gap. These gaps interact with spiritual and alternative care practices that aim to safeguard pregnancy and prevent complications. Structural factors related to poverty and disrespectful care in health facilities compounded to limit the utilisation of formal healthcare. Conclusions: The combined use of BDHS and qualitative data contributed to highlighting critical gaps along the maternal CoC. A lack of integration of spiritual or alternative aspects of care into biomedical services, as well as structural factors, impeded access to healthcare in Benin.
This mixed‐methods study employed a triangulation design, in standard notation QUAL + quan. Primary data collection in the qualitative strand and the analysis of secondary data in the quantitative strand occurred separately. The results from the qualitative study prompted a targeted exploration of certain variables (i.e. identified gaps and variations in the use of health services) in the BDHS. Findings from each strand were integrated during interpretation. Data were collected between 2018 and 2019 in selected villages in the Atlantique region in the South of Benin. Study sites were selected in light of observed variations in the use of services along the CoC of maternal health [20]. Moreover, the ancient kingdom of Allada is still considered a reference point for pre‐colonial cultures and practices related to birth, life, sexuality, reproduction, and death in southern Benin. The research team was composed of three anthropologists and three public health physicians. Three of the researchers were able to speak the Fon language with participants. Prior to the start of data collection, political and health authorities in the three communes of the Allada‐Toffo‐Zè health zone were contacted to negotiate their support and assistance throughout the study, a crucial step. Potential participants were approached at the community level and in healthcare facilities for social interaction. Access to participants was achieved primarily through snowball sampling. Fieldwork continued until theoretical saturation was reached. The following ethnographic techniques were used: The target population for this study was healthcare users and non‐users and providers in the public, private, traditional and home care sectors, targeting pre‐pregnancy, pregnancy, childbirth and postnatal care. Participants were selected based on the principles of theoretical sampling, where the researcher simultaneously collects and analyses data based on existing theories to guide the next phase of the research and selection of new participants. Sampling also aimed to progressively select for maximum variation in profiles in terms of localities, gender, age, marital status, socioeconomic status, occupation, religious beliefs, ethnicity and (non‐)use of formal maternal health services (Table (Table11). Participant profiles In the initial phase of research, inductive coding of raw data was done. When new hypotheses and theories were formed, question guides were adapted accordingly, and further tested in the field until theoretical saturation was reached. After all data were collected, deductive coding was done on all raw data in Nvivo 12 Qualitative Analysis Software. A final coding framework was constructed based on the results of the analytic process during fieldwork and an analytical workshop in which all researchers involved in the project participated. Coding queries were performed to test relationships between codes or between codes and attributes of respondents. We used the most recent BDHS from 2017 to 2018. The DHS are nationally representative surveys of households. We identified five CoC elements or steps from ANC to PNC (details in File S1) and estimated the percentage of women receiving each of the five steps separately, and then cumulatively. Analysis was conducted in STATA v14. The BDHS 2017–18 received approvals from the National Statistics Council and the National Ethics Committee for Health Research in Benin. As DHS data are secondary data, our analyses did not require any additional ethical approvals. The ethnographic study protocol was approved by the Local Ethics Committee for Biomedical Research of the University of Parakou in Benin (approval number: 0092/CLERB‐UP/P/SP/R/SA), and the Institute of Tropical Medicine Antwerp in Belgium (approval number: IRB/AB/AC/044). All participants were thoroughly informed about the study aims, content, benefits, risks and confidentiality issues including their right to withdraw consent at any time without having to provide a reason for withdrawal or having to fear negative consequences. Written informed consent was sought from interviewees participating in in‐depth interviews, while participants in informal conversation as part of participant observation provided oral consent, documented by the researcher and a witness.
