Barriers to accessing adequate maternal care in Georgia: A qualitative study

E. Miteniece, M. Pavlova, L. Shengelia, B. Rechel, W. Groot

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: The maternal health outcomes in Georgia are linked to shortcomings in healthcare such as inequities in access to adequate maternal care. Due to the macro-level, quantitative approach applied in most previous studies, little is known about the underlying reasons that influence maternal care and care-seeking behaviour of pregnant women. Methods: This qualitative study explores the stakeholders' perspectives on access to adequate maternal care in Georgia. Focus-group discussions are conducted with mothers who gave birth within in the past four years and in-depth interviews are conducted with decision-makers and health professionals in the field. Five access-related aspects are studied: availability, appropriateness, affordability, approachability and acceptability of maternal care. The method of direct content analysis is applied. Results: Results indicate problems with maternal care standards, inequalities across population groups and drawbacks in maternal care financing. This includes gaps in clinical quality and staff skills, as well as poor communication between women and health professionals. Geographical barriers to adequate maternal care exist in rural and mountainous areas due to the weak infrastructure (poor roads and weak transportation), in addition to financial hardships. Despite improvements in the coverage of maternal care, affordability remains an access barrier. Poorer population groups are financially unprotected from the high out-of-pocket payments for maternal care services. Conclusion: These findings imply that micro-level indicators, such as disrespectful behaviour of health professionals and affordability of care, should be taken into account when assessing maternal care provision in Georgia. It should complement the existing macro-level indicators for a comprehensive evaluation of maternal care.
Original languageEnglish
Article number631
Number of pages12
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
Publication statusPublished - 13 Aug 2018

Keywords

  • Access
  • Approachability
  • Appropriateness
  • Cost
  • Georgia, Central and Eastern Europe
  • Maternal care
  • Pregnancy
  • adult
  • article
  • content analysis
  • Eastern Europe
  • female
  • financial management
  • human
  • interview
  • maternal care
  • mother
  • population group
  • pregnancy
  • qualitative research
  • skill
  • staff
  • MORTALITY
  • Central and Eastern Europe
  • HEALTH
  • Georgia
  • Professional-Patient Relations
  • Humans
  • Maternal Health Services/economics
  • Patient Satisfaction
  • Georgia (Republic)/epidemiology
  • Health Services Accessibility
  • Rural Population
  • Health Personnel
  • Pregnant Women
  • Female
  • Interviews as Topic
  • Healthcare Disparities/economics
  • Maternal Mortality
  • Focus Groups
  • Health Expenditures
  • Patient Acceptance of Health Care
  • Qualitative Research

Cite this

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title = "Barriers to accessing adequate maternal care in Georgia: A qualitative study",
abstract = "Background: The maternal health outcomes in Georgia are linked to shortcomings in healthcare such as inequities in access to adequate maternal care. Due to the macro-level, quantitative approach applied in most previous studies, little is known about the underlying reasons that influence maternal care and care-seeking behaviour of pregnant women. Methods: This qualitative study explores the stakeholders' perspectives on access to adequate maternal care in Georgia. Focus-group discussions are conducted with mothers who gave birth within in the past four years and in-depth interviews are conducted with decision-makers and health professionals in the field. Five access-related aspects are studied: availability, appropriateness, affordability, approachability and acceptability of maternal care. The method of direct content analysis is applied. Results: Results indicate problems with maternal care standards, inequalities across population groups and drawbacks in maternal care financing. This includes gaps in clinical quality and staff skills, as well as poor communication between women and health professionals. Geographical barriers to adequate maternal care exist in rural and mountainous areas due to the weak infrastructure (poor roads and weak transportation), in addition to financial hardships. Despite improvements in the coverage of maternal care, affordability remains an access barrier. Poorer population groups are financially unprotected from the high out-of-pocket payments for maternal care services. Conclusion: These findings imply that micro-level indicators, such as disrespectful behaviour of health professionals and affordability of care, should be taken into account when assessing maternal care provision in Georgia. It should complement the existing macro-level indicators for a comprehensive evaluation of maternal care.",
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author = "E. Miteniece and M. Pavlova and L. Shengelia and B. Rechel and W. Groot",
note = "Correspondence Address: Miteniece, E.; Department of Health Services Research, Maastricht University, Faculty of Health, Medicine and Life Sciences, Duboisdomein 30, Netherlands; email: e.miteniece@maastrichtuniversity.nl",
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Barriers to accessing adequate maternal care in Georgia : A qualitative study. / Miteniece, E.; Pavlova, M.; Shengelia, L.; Rechel, B.; Groot, W.

In: BMC Health Services Research, Vol. 18, No. 1, 631, 13.08.2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Barriers to accessing adequate maternal care in Georgia

T2 - A qualitative study

AU - Miteniece, E.

AU - Pavlova, M.

AU - Shengelia, L.

AU - Rechel, B.

AU - Groot, W.

N1 - Correspondence Address: Miteniece, E.; Department of Health Services Research, Maastricht University, Faculty of Health, Medicine and Life Sciences, Duboisdomein 30, Netherlands; email: e.miteniece@maastrichtuniversity.nl

PY - 2018/8/13

Y1 - 2018/8/13

N2 - Background: The maternal health outcomes in Georgia are linked to shortcomings in healthcare such as inequities in access to adequate maternal care. Due to the macro-level, quantitative approach applied in most previous studies, little is known about the underlying reasons that influence maternal care and care-seeking behaviour of pregnant women. Methods: This qualitative study explores the stakeholders' perspectives on access to adequate maternal care in Georgia. Focus-group discussions are conducted with mothers who gave birth within in the past four years and in-depth interviews are conducted with decision-makers and health professionals in the field. Five access-related aspects are studied: availability, appropriateness, affordability, approachability and acceptability of maternal care. The method of direct content analysis is applied. Results: Results indicate problems with maternal care standards, inequalities across population groups and drawbacks in maternal care financing. This includes gaps in clinical quality and staff skills, as well as poor communication between women and health professionals. Geographical barriers to adequate maternal care exist in rural and mountainous areas due to the weak infrastructure (poor roads and weak transportation), in addition to financial hardships. Despite improvements in the coverage of maternal care, affordability remains an access barrier. Poorer population groups are financially unprotected from the high out-of-pocket payments for maternal care services. Conclusion: These findings imply that micro-level indicators, such as disrespectful behaviour of health professionals and affordability of care, should be taken into account when assessing maternal care provision in Georgia. It should complement the existing macro-level indicators for a comprehensive evaluation of maternal care.

AB - Background: The maternal health outcomes in Georgia are linked to shortcomings in healthcare such as inequities in access to adequate maternal care. Due to the macro-level, quantitative approach applied in most previous studies, little is known about the underlying reasons that influence maternal care and care-seeking behaviour of pregnant women. Methods: This qualitative study explores the stakeholders' perspectives on access to adequate maternal care in Georgia. Focus-group discussions are conducted with mothers who gave birth within in the past four years and in-depth interviews are conducted with decision-makers and health professionals in the field. Five access-related aspects are studied: availability, appropriateness, affordability, approachability and acceptability of maternal care. The method of direct content analysis is applied. Results: Results indicate problems with maternal care standards, inequalities across population groups and drawbacks in maternal care financing. This includes gaps in clinical quality and staff skills, as well as poor communication between women and health professionals. Geographical barriers to adequate maternal care exist in rural and mountainous areas due to the weak infrastructure (poor roads and weak transportation), in addition to financial hardships. Despite improvements in the coverage of maternal care, affordability remains an access barrier. Poorer population groups are financially unprotected from the high out-of-pocket payments for maternal care services. Conclusion: These findings imply that micro-level indicators, such as disrespectful behaviour of health professionals and affordability of care, should be taken into account when assessing maternal care provision in Georgia. It should complement the existing macro-level indicators for a comprehensive evaluation of maternal care.

KW - Access

KW - Approachability

KW - Appropriateness

KW - Cost

KW - Georgia, Central and Eastern Europe

KW - Maternal care

KW - Pregnancy

KW - adult

KW - article

KW - content analysis

KW - Eastern Europe

KW - female

KW - financial management

KW - human

KW - interview

KW - maternal care

KW - mother

KW - population group

KW - pregnancy

KW - qualitative research

KW - skill

KW - staff

KW - MORTALITY

KW - Central and Eastern Europe

KW - HEALTH

KW - Georgia

KW - Professional-Patient Relations

KW - Humans

KW - Maternal Health Services/economics

KW - Patient Satisfaction

KW - Georgia (Republic)/epidemiology

KW - Health Services Accessibility

KW - Rural Population

KW - Health Personnel

KW - Pregnant Women

KW - Female

KW - Interviews as Topic

KW - Healthcare Disparities/economics

KW - Maternal Mortality

KW - Focus Groups

KW - Health Expenditures

KW - Patient Acceptance of Health Care

KW - Qualitative Research

U2 - 10.1186/s12913-018-3432-z

DO - 10.1186/s12913-018-3432-z

M3 - Article

VL - 18

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 1

M1 - 631

ER -