The "Blessing" of Pregnancy? Barriers to accessing adequate maternal care in Poland: A mixed-method study among women, healthcare providers, and decision-makers

OBJECTIVE: All women should have access to adequate and respectful maternal care to maximise health outcomes. In Poland, there is a mismatch between good maternal health indicators and poor care experiences. This study examined stakeholder views on access to adequate maternal care in Poland in terms of availability, appropriateness, affordability, approachability, and acceptability.

DESIGN: A mixed-methods study.

SETTING: Online survey and online semi-structured interviews conducted between March 2021 and May 2021.

PARTICIPANTS: Five-hundred fifty-seven (557) women who recently gave birth in Poland, maternal care providers and decision-makers active in the field of maternal health.

FINDINGS: The main barriers to adequate care were inappropriate communication of maternal care providers, insufficient compliance with standards of care, over-medicalisation of childbirth and suboptimal engagement of women in care provision, and high levels of out-of-pocket spending on maternal care services. Other barriers included limited availability of maternal care providers, particularly midwives, and low reproductive health literacy in women.

KEY CONCLUSIONS: Provision of adequate and women-centred maternal care remains erratic, despite substantial care provision advancements in recent years. Addressing the barriers could substantially improve the experience of and access to adequate maternal care in Poland.

IMPLICATIONS FOR PRACTICE: Barriers identified in the survey with women largely converged with those highlighted in the interviews. In addition, maternal care providers and decision-makers provided context-specific information and explanation of the current state of maternal care system. Consequently, this study provides direction-setting information for policy and practice in Poland and other Central and Eastern European countries, which share similar shortcomings related to adequate maternal care provision.