Expectations and experiences of women regarding maternal healthcare services in Pakistan: challenges and lessons to be learnt

Abstract

Background Access to maternal healthcare services is an essential pre-requisite for improving women’s health. However, due to poor access and underutilization, women in developing countries remain vulnerable to various complications. Evaluation of quality maternal healthcare services in any country must include the opinions of the women being as a key stakeholder utilizing maternal healthcare services. Aim The present study was designed to evaluate the experiences, perceptions and expectations of pre-birth and post-birth women regarding utilization and delivery of maternal healthcare services in Pakistan. Methodology A qualitative study design was used. Snow ball sampling technique was adopted to identify the respondents. Interviews were conducted using semi-structures interview guide till saturation point was achieved. The sample size at saturation point for different respondents was: pre-birth women (n = 9) and post-birth women (n = 9). All interviews were recorded after getting permission from the respondents. The interviews were transcribed verbatim and were then subjected to thematic analysis. Results The age group for the pre-birth respondents was 23–43 years while for post-birth group it was 23–32 years. Most of the respondents from both groups were from urban setting. Most of them were either first time pregnant or were having experience of one pregnancy. Thematic analysis of the interviews yielded different themes and sub-themes including birth experience, maternal treatment pathway, identified barriers for quality maternal care, involvement in healthcare decision-making, impact of Covid 19, payment dynamics, role of digital health and recommendations for improving maternal care services. Conclusion The results of the present study concluded that the overall quality of the maternal care services provided in Pakistan was not up to the mark. High rate of caesarian section was prevalent. Majority of the women were not involved in the decision-making process or provided with any birth plan or counselling regarding birth signs, family planning, danger and birth signs. The cost of maternal care was quite high and not affordable for all.

Pregnant Women’s Perceptions of the Quality of Antenatal Care in a Public Hospital in Punjab, Pakistan during COVID-19: A Cross-Sectional Study

“…Anticipatory guidance, which prepares mothers for the process of delivery and labor, guides them about breastfeeding practices, and creates awareness about the significance of light exercise and nutrition, etc., was also not considered of good quality by the users. Similar findings were reported in a qualitative study done in twin cities of Pakistan during the pandemic [ 38 ]. Another qualitative study done in Pakistan during the pandemic disclosed that it was difficult to find doctors, nurses, or health centers that could provide the necessary services during that period.…”

Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review

“…While a minority (23%) of new mothers worried about not being able to breastfeed [30] , most mothers (50% to 94%) breastfed during their hospital stay [37] , [38] , [52] , [62] , [85] of which 48.3% to 89.3% reported receiving adequate breastfeeding support. Furthermore, a comparison of breastfeeding rates between COVID positive mothers and COVID negative mothers showed no difference between groups [39] , [73] , with 57% [81] to 69% [46] of COVID positive mothers doing direct breastfeeding during their hospital stay. However, qualitative findings revealed that mothers who were unable to get in-person breastfeeding support or had virtual lactation consultation instead reported more difficulty in breastfeeding [44] , [50] , [57] , [75] , [78] with some resorting to a change to formula feeding [43] , [45] .…”

“…More than half the mothers (51.8% to 55.1%) in McMillan [64] , Sanders and Blaylock [41] and Burgess [51] studies reported a change to virtual antenatal visits or telephone or video calls. Some mothers praised virtual consultations and telemedicine as time-saving, efficient, and providing access to healthcare professionals [40] , [56] , [59] , [73] . Although 61.4% of mothers in Burgess’ study [51] were satisfied with virtual care and 86% reported adequate antenatal care, 93.2% still preferred face-to-face classes.…”

“…Mothers were also concerned about not having physical check-ups to gauge whether their pregnancy was going fine [57] , [59] , [65] , [68] , [69] , [77] and whether the lack of in-person antenatal classes would affect their childbirth and childcare abilities [44] , [68] . In-person antenatal appointments were harder to schedule and reduced in frequency with shorter consultation time and longer intervals, which led to anxiety and nervousness among mothers, especially those with medical complications [40] , [41] , [44] , [51] , [57] , [59] , [69] , [71] , [73] , [78] . A survey by Meaney and colleagues [40] reported that 38.2% of mothers preferred more antenatal check-ups, and 34.3% found the interval between appointments to be too long and 35% would prefer more time with the healthcare professionals.…”

“…Qualitative findings also highlighted the absence of postpartum support from healthcare professionals [41] , [43] , [44] , [54] , [65] , [75] , [78] , where the lack of follow up doctor appointments for mother and baby and no home visits from health visitors caused mothers to feel abandoned, unsure, and worried as to whether the baby was hitting all the developmental milestones and if they were recovering properly from birth [43] , [78] . Although some mothers were appreciative of virtual or telephone postpartum follow up [59] , [73] , it was found to be still inadequate in assessing mother and child’s physical and mental health [65] , [75] , [78] , [83] .…”