Sacks Emma, Masvawure Tsitsi B, Atuyambe Lynn M, Neema Stella, Macwan'gi Mubiana, Simbaya Joseph, Kruk Margaret
Department of Epidemiology, Columbia University Medical Center, 722 W 168 Street, New York, NY, 10032, USA.
USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington, DC, USA.
Matern Child Health J. 2017 Mar;21(3):599-606. doi: 10.1007/s10995-016-2144-4.
Objectives The objective of this study was to examine experiences with, and barriers to, accessing postnatal care services, in the context of a maternal health initiative. Methods As part of a larger evaluation of an initiative to promote facility deliveries in 8 rural districts in Uganda and Zambia, 48 focus groups were held with recently-delivered women with previous home and facility deliveries (6 per district). Data on postnatal care experiences were translated, coded and analyzed using thematic content analysis techniques. Results were categorized into: positive postnatal care experiences, barriers to postnatal care utilization, and negative postnatal care experiences. Results Women who accessed care largely reported positive experiences, with Zambian women generally reporting more positive interactions than Ugandan women. The main reasons given for low postnatal care utilization were low awareness about the need, fear of mistreatment by clinic staff, cost and distance. In half of the focus groups, women described personal experience or knowledge of denial or threatened denial of postnatal care due to the birth location. Although outright denial of care was not common, women frequently described various types of actual or presumed discrimination because of having a home birth. Conclusions for Practice While many women reported positive experiences with postnatal care utilization, cases of delay or denial of postnatal care exist. As programs incentivize facility deliveries, the lack of focus on postnatal support may place home-delivered newborns in "double jeopardy" due to poor quality intra-partum care and reduced access to postnatal care.
目标 本研究的目的是在一项孕产妇健康倡议的背景下，调查获得产后护理服务的经历及障碍。方法 作为对乌干达和赞比亚8个农村地区促进机构分娩倡议进行的一项更大规模评估的一部分，与近期有过在家分娩和机构分娩经历的产妇举行了48次焦点小组讨论（每个地区6次）。使用主题内容分析技术对产后护理经历的数据进行翻译、编码和分析。结果分为：积极的产后护理经历、产后护理利用的障碍和消极的产后护理经历。结果 获得护理的妇女大多报告了积极的经历，赞比亚妇女普遍比乌干达妇女报告了更多积极的互动。产后护理利用率低的主要原因是对需求的认识不足、担心受到诊所工作人员的虐待、费用和距离。在一半的焦点小组中，妇女描述了因分娩地点而被拒绝或被威胁拒绝产后护理的个人经历或所知情况。虽然直接拒绝护理并不常见，但妇女经常描述因在家分娩而受到的各种实际或推定的歧视。实践结论 虽然许多妇女报告了产后护理利用的积极经历，但仍存在产后护理延迟或被拒绝的情况。随着各项计划鼓励机构分娩，由于产时护理质量差和获得产后护理的机会减少，对产后支持缺乏关注可能会使在家分娩的新生儿面临“双重危险”。
