Cited by 136Global Maternal and Child HealthHealth and Conflict StudiesReproductive Health and Contraception

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A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda

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Chi, Primus Che, Bulage, Patience, Urdal, Henrik, Sundby, Johanne·2015·BMC Pregnancy and Childbirth

DOI 10.1186/s12884-015-0449-8PMC PMC4327793

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Abstract

BACKGROUND: Armed conflict has been described as an important contributor to the social determinants of health and a driver of health inequity, including maternal health. These conflicts may severely reduce access to maternal health services and, as a consequence, lead to poor maternal health outcomes for a period extending beyond the conflict itself. As such, understanding how maternal health-seeking behaviour and utilisation of maternal health services can be improved in post-conflict societies is of crucial importance. This study aims to explore the determinants (barriers and facilitators) of women's uptake of maternal, sexual and reproductive health services (MSRHS) in two post-conflict settings in sub-Saharan Africa; Burundi and Northern Uganda, and how uptake is affected by exposure to armed conflict. METHODS: This is a qualitative study that utilised in-depth interviews and focus group discussions (FGDs) for data collection. One hundred and fifteen participants took part in the interviews and FGDs across the two study settings. Participants were women of reproductive age, local health providers and staff of non-governmental organizations. Issues explored included the factors affecting women's utilisation of a range of MSRHS vis-à-vis conflict exposure. The framework method, making use of both inductive and deductive approaches, was used for analyzing the data. RESULTS: A complex and inter-related set of factors affect women's utilisation of MSRHS in post-conflict settings. Exposure to armed conflict affects women's utilisation of these services mainly through impeding women's health seeking behaviour and community perception of health services. The factors identified cut across the individual, socio-cultural, and political and health system spheres, and the main determinants include women's fear of developing pregnancy-related complications, status of women empowerment and support at the household and community levels, removal of user-fees, proximity to the health facility, and attitude of health providers. CONCLUSIONS: Improving women's uptake of MSRHS in post-conflict settings requires health system strengthening initiatives that address the barriers across the individual, socio-cultural, and political and health system spheres. While addressing financial barriers to access is crucial, attention should be paid to non-financial barriers as well. The goal should be to develop an equitable and sustainable health system.

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Figure 1 Reproductive health outlook for Burundi and Uganda. Source of data: UN MDG indicators monitoring database (http://mdgs.un.org/unsd/mdg/data.aspx). SBA: Skilled birth attendance; CPR: Current contraceptive use among married women 15–49 years old, any method; ANC 1: Antenatal care coverage, at least one visit; ANC 4: Antenatal care coverage, at least four visits; FP: Family planning.CC BY · PubMed Central

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Authors: Chi, P. C., Bulage, P., Urdal, H., & Sundby, J.
Affiliations: University of Oslo (NO)
International Organization for Migration (CH)
Peace Research Institute Oslo (NO)
Corresponding author: Chi, Primus Che
ORCID: Chi, Primus Che
Urdal, Henrik
Sundby, Johanne
Venue: BMC Pregnancy and Childbirth
Publisher: Springer Science and Business Media LLC
Published: 2015-02-05
Volume: 15
Issue: 1
Pages: 18-18
ISSN: 1471-2393 (ISSN-L)
DOI: 10.1186/s12884-015-0449-8
PMC: PMC4327793
OpenAlex: W2055795844
Cited by: 136
References: 41
Citations by year: 2026: 10 · 2025: 6 · 2024: 27 · 2023: 11 · 2022: 13 · 2021: 15 · 2020: 12 · 2019: 13 · 2018: 11 · 2017: 8 · 2016: 5 · 2015: 5
FWCI: 9.65
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (unspecified)
Locations: BMC Pregnancy and Childbirth (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Funders: European Commission (263905)
Universitetet i Oslo
Norges Forskningsråd (230861)
Folke Bernadotteakademin
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords: post-conflict societies, armed conflict exposure, health-seeking behavior, barriers and facilitators, women's empowerment, health system strengthening, user fees, clinician attitudes, health disparities, Burundi, Northern Uganda
MeSH terms: Maternal Health, Armed Conflicts, Adult, Burundi, Female, Humans, Health Knowledge, Attitudes, Practice, Maternal Health Services, Patient Acceptance of Health Care, Pregnancy, Uganda, Focus Groups, Reproductive Health Services, Qualitative Research

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A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda

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