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

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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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
Issue number1
Publication statusPublished - 13 Aug 2018

JEL classifications

  • i15 - Health and Economic Development
  • i14 - Health and Inequality
  • i11 - Analysis of Health Care Markets
  • j24 - "Human Capital; Skills; Occupational Choice; Labor Productivity"
  • i39 - Welfare and Poverty: Other


  • 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
  • Central and Eastern Europe
  • 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

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