The lived experience, perceptions, and barriers of continuum of maternal health care services utilization: a qualitative study

Abstract

Maternal health, encompassing women’s well-being during pregnancy, childbirth, and postpartum, remains a critical public health concern. Despite numerous interventions in Ethiopia, only a small proportion of women complete the full continuum of care. However, the underlying reasons remain unclear, highlighting the need to investigate the complex, context-specific realities, perception, and barriers that shape maternal health service use. This qualitative study aims to explore these aspects in depth, revealing the nuanced factors that influence women’s engagement in the maternal continuum of care. The study employed a phenomenological qualitative design, involving women who had given birth in the past 12 months, their husbands, healthcare providers, community health workers, and health service leaders. Using purposive sampling to ensure diverse perspectives, data were collected through in-depth interviews, key informant interviews, and focus group discussions with semi-structured interview guides and protocols. Thematic analysis was performed using Open Code software, with meticulous data transcription and review for accuracy. Quality assurance included pilot testing, standardized procedures, and comprehensive training for data collectors. Ethical clearance was obtained, and confidentiality was upheld throughout the study. The study identifies critical obstacles to the continuum of effective maternal health care, including negative past experiences and poor conditions in maternity waiting homes. Community perceptions, such as fears of pain from vaccinations and scepticism about follow-up care, further hinder care-seeking behaviour. Women often wait for health professionals to initiate communication and may feel their decision-making autonomy is constrained by economic dependence and gender norms. Additional challenges include heavy workloads, lack of partner support, and limited access to health facilities exacerbated by geographical and logistical issues. Inadequate infrastructure, unreliable ambulance services, and insufficient professional skills and compassion also contribute to these difficulties. The study highlights significant barriers to the continuum of maternal health care, including negative past experiences, poor facilities, and community misconceptions. To improve care, it is crucial to address these issues by enhancing healthcare infrastructure, improving professional skills and empathy, and fostering better communication and support for women’s autonomy and decision-making.