Women’s experiences of maternal and newborn health care services and support systems in Buikwe District, Uganda: A qualitative study

Abstract

Background Uganda continues to have a high neonatal mortality rate, with 20 deaths per 1000 live births reported in 2018. A measure to reverse this trend is to fully implement the Uganda Clinical Guidelines on care for mothers and newborns during pregnancy, delivery and the postnatal period. This study aimed to describe women’s experiences of maternal and newborn health care services and support systems, focusing on antenatal care, delivery and the postnatal period. Methods We used triangulation of qualitative methods including participant observations, semi-structured interviews with key informants and focus group discussions with mothers. Audio-recorded data were transcribed word by word in the local language and translated into English. All collected data material were stored using two-level password protection or stored in a locked cabinet. Malterud’s Systematic text condensation was used for analysis, and NVivo software was used to structure the data. Findings Antenatal care was valued by mothers although not always accessible due to transport cost and distance. Mothers relied on professional health workers and traditional birth attendants for basic maternal services but expressed general discontentment with spousal support in maternal issues. Financial dependency, gender disparities, and lack of autonomy in decision making on maternal issues, prohibited women from receiving optimal help and support. Postnatal follow-ups were found unsatisfactory, with no scheduled follow-ups from professional health workers during the first six weeks. Conclusions Further focus on gender equity, involving women’s right to own decision making in maternity issues, higher recognition of male involvement in maternity care and improved postnatal follow-ups are suggestions to policy makers for improved maternal care and newborn health in Buikwe District, Uganda.

What does your partner want? Using a gender equality lens to assess partner support and involvement in Family Planning in Uganda

“…Implications for SBC programming SBC interventions can positively change gender norms and household power dynamics to improve well-being across multiple areas, including family planning and reproductive health. Our study corroborates existing literature on the importance of partner support for contraceptive use (14)(15)(16)(17)(18)(19)(20)23). We show that while men and women mostly want their partners to support them in similar ways, they de ne this support differently.…”

“…A study conducted in rural Uganda demonstrated that women who found it di cult to have conversations with their partner about reproductive health issues, including family planning, were signi cantly more likely to have symptoms of depression and anxiety compared to women who found these conversations easy (15). Other studies also conducted in Uganda found that the majority of women expressed a general discontent with partner involvement in reproductive health, with many women describing a lack of autonomy in decision-making about their health (16,17). These studies cited nancial dependency, gender disparities, lack of autonomy, poor communication between couples, and perceptions regarding social norms as major challenges to reproductive health service utilization (16,17).…”

“…Other studies also conducted in Uganda found that the majority of women expressed a general discontent with partner involvement in reproductive health, with many women describing a lack of autonomy in decision-making about their health (16,17). These studies cited nancial dependency, gender disparities, lack of autonomy, poor communication between couples, and perceptions regarding social norms as major challenges to reproductive health service utilization (16,17). More broadly, these couple-centric challenges to reproductive health care act as a barrier to achieving the ideals of gender equality by preventing both women and men from achieving their fullest potential, as individuals and as couples.…”

Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens

“…Long travel time remains a challenge among women in remote areas even where interventions have been implemented [90,98] and has been linked with lack of public transport and roads in poor conditions [89,[99][100][101]. Access to bicycles has shown to be a pro-poor option in increasing access to health centers and can be used as entry point to intervene on areas with poor geographical access [100], supplemented with contracted transporters [77].…”

Are midwives ready to provide quality evidence-based care after pre-service training? Curricula assessment in four countries—Benin, Malawi, Tanzania, and Uganda

“…Our findings indicate that gaps in pre-service training curricula were consistent across the study countries, with a lack of focus on woman centered care, information sharing and shared decision making, care related to women who experience physical and sexual violence and abuse as well as aspects concerning fundamental human rights when providing midwifery care. These aspects of respectful care have been described as missing in a number of studies despite being seen as very critical in relation to women's experiences during the pregnancy, childbirth and postnatal continuum, as well as important in promoting the use of facility-based maternity care [27][28][29][30][31].…”