Introduction: To reduce maternal morbidity, mortality and improve neonatal health, government has focused on improving access and supply of maternal health services. Despite these efforts, maternal morbidity and mortality remain a major public health problem in Uganda. This study explores the factors and challenges experienced in utilizing ANC and choosing a delivery place in order to inform the implementation of a proposed intervention aimed at improving access to maternal delivery services.
Methodology: This was a qualitative study that employed Focus Group Discussion (FGD’s). Participants were purposively sampled. Six FGD’s were conducted among women aged 15-49 years who had ever had a child and were residing in eastern Uganda in the districts of Kamuli, Soroti, Tororo and Pallisa. All data was tape recorded with consent from participants and transcribed thereafter. Typed data was analyzed manually using qualitative thematic analysis techniques.
Results: The majority of respondents attended ANC at least once. The major limitations to accessing ANC services were long distance and high transport costs to health care facilities. All FGD’s reported that health centres, traditional birth attendant (TBA’s), homes and private clinics were the usual delivery sites. Despite the noted benefits of health facility deliveries many barriers deterred utilization of formal delivery services. These included; user fees charged, hospital requirements, long distance to health facilities and rude service providers. TBA’s were appreciated because of the hospital training they had acquired and the flexibility of their services in terms of payment and the site of provision. Home deliveries were viewed as potentially risky but due to high transport costs were at times the only affordable option. Participants expressed excitement over the upcoming project and believed it would improve accessibility to maternal health services.
Conclusion and implications: The findings of this study indicate that demand side barriers such as transport and cost of maternal health services are a major challenge affecting utilization. Services offered by TBA’s were more accessible in terms of distance and cost. Interventions to improve the attitude of health workers and ensure abolition of informal fees may be helpful in improving utilization of formal services. It was believed that a project to provide free transport for accessing maternal health services would greatly improve the health of women in the region.