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A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda
Open accessAbstract
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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“Adverse social and health impacts of armed conflict, beyond direct loss of lives on the battlefield, commonly include nutrition-related child stunting and wasting, increased disease exposure, reduced availability and use of health clinics, loss of schooling, mental trauma, and lowered life satisfaction (137-142).”
From Vicious Circles: Violence, Vulnerability, and Climate Change (2021) · cites this paper as [138]
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Metadata
- 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
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2015-02-05
- Volume
- 15
- Issue
- 1
- Pages
- 18-18
- ISSN
- 1471-2393 (ISSN-L)
- 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
- 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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