School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
PLoS One. 2020 Aug 11;15(8):e0237002. doi: 10.1371/journal.pone.0237002. eCollection 2020.
Increased maternal health care (MHC) service utilisation in Bangladesh over the past decades has contributed to improvements in maternal health outcomes nationally, yet there is little understanding of Indigenous women's experiences of accessing MHC services in Bangladesh.
Face-to-face semi-structured qualitative interviews with 21 Indigenous women (aged 15-49 years) within 36 months of delivery from three ethnic groups (Chakma, Marma and Tripura) were conducted between September 2017 and February 2018 in Khagrachhari district. Purposive sampling was used to recruit women representative of the population distribution in terms of age, ethnic community and service use experience. All interviews were conducted in Bangla language and audio-recorded with consent. Interviews were transcribed directly into English before being coded. Data were analysed thematically using a qualitative descriptive approach aided by NVivo12 software.
Of the 21 women interviewed, 14 had accessed at least one MHC service during their last pregnancy or childbirth and were categorised as the User group. The remaining seven participants were categorised as 'Non-users' as they had not access antenatal care, facility delivery or postnatal care services. Women reported that they wanted culturally relevant, respectful, home-based and affordable care, and generally perceived formal MHC services as being only for complications and emergencies. Barriers to accessing MHC services included low levels of understanding about the importance of MHC services, concerns about service costs, limited transport and fears of intrusive practices. Experiences within health services that deterred women from accessing future MHC services included demands for unofficial payments and abusive treatment by public facility staff.
Improving access to MHC services for the CHT Indigenous women requires improved understandings of cultural values, priorities and concerns. Multifaceted reform is needed at individual, community and health systems levels to offer culturally appropriate health education and flexible service delivery options.
在过去几十年中，孟加拉国增加了孕产妇保健（MHC）服务的利用，这有助于改善全国孕产妇健康状况，但对于孟加拉国土著妇女获得 MHC 服务的经验却知之甚少。
2017 年 9 月至 2018 年 2 月期间，在吉大港山区对三个民族（Chakma、Marma 和 Tripura）的 21 名在分娩后 36 个月内的土著妇女（年龄在 15-49 岁之间）进行了面对面的半结构化定性访谈。采用目的抽样法，根据年龄、族裔社区和服务使用经验，招募具有代表性的妇女。所有访谈均以孟加拉语进行，并征得同意进行录音。访谈内容直接翻译成英文，然后进行编码。使用 NVivo12 软件，通过定性描述方法对数据进行主题分析。
在接受采访的 21 名妇女中，有 14 名在最近的怀孕或分娩期间至少使用过一种 MHC 服务，被归类为“使用者”群体。其余 7 名参与者被归类为“非使用者”，因为他们没有接受产前护理、住院分娩或产后护理服务。妇女们表示，她们希望获得文化相关、尊重、家庭为基础且负担得起的护理，并且普遍认为正规 MHC 服务仅适用于并发症和紧急情况。获得 MHC 服务的障碍包括对 MHC 服务重要性的理解程度低、对服务费用的担忧、交通有限以及对侵犯性做法的恐惧。阻碍妇女获得未来 MHC 服务的卫生服务体验包括对非官方付款的要求和公共设施工作人员的虐待待遇。
为改善 CHT 土著妇女获得 MHC 服务的机会，需要更好地了解文化价值观、优先事项和关注点。需要在个人、社区和卫生系统层面进行多方面的改革，提供文化上适当的健康教育和灵活的服务提供选择。
