Makerere University, School of Public Health, College of Health Sciences, Kampala, Uganda.
Muni University, Faculty of Health Sciences, Arua, Uganda.
Medicine (Baltimore). 2022 Jul 29;101(30):e29698. doi: 10.1097/MD.0000000000029698.
Globally, 298,000 women die due to pregnancy related causes and half of this occurs in Africa. In Uganda, maternal mortality has marginally reduced from 526 to 336 per 100,000 live births between 2001 and 2016. Health facility delivery is an important factor in improving maternal and neonatal outcomes. However, the concept of using a skilled birth attendant is not popular in Uganda. An earlier intervention to mobilize communities in the Masindi region for maternal and newborn health services discovered that immigrant populations used maternal health services less compared to the indigenous populations. The aim of this qualitative study was therefore to better understand why immigrant populations were using maternal health services less and what the barriers were in order to suggest interventions that can foster equitable access to maternal health services. Five focus group discussions (FGDs) (three among women; 2 with men), 8 in-depth interviews with women, and 7 key informant interviews with health workers were used to better understand the experiences of immigrants with maternal and newborn services. Interviews and FGDs were conducted from July to September 2016. Data were analyzed using content analysis and intersectionality. Results were based on the following thematic areas: perceived discrimination based on ethnicity as a barrier to access, income, education and gender. Immigrant populations perceived they were discriminated against because they could not communicate in the local dialect, they were poor casual laborers, and/or were not well schooled. Matters of pregnancy and childbearing were considered to be matters for women only, while financial and other decisions at the households are a monopoly of men. The silent endurance of labor pains was considered a heroic action. In contrast, care-seeking early during the onset of labor pains attracted ridicule and was considered frivolous. In this context, perceived discrimination, conflicting gender roles, and societal rewards for silent endurance of labor pains intersect to create a unique state of vulnerability, causing a barrier to access to maternal and newborn care among immigrant women. We recommend platforms to demystify harmful cultural norms and training of health workers on respectful treatment based on the 12 steps to safe and respectful mother baby-family care.
全球范围内，有 29.8 万名妇女因妊娠相关原因死亡，其中一半发生在非洲。在乌干达，2001 年至 2016 年期间，每 10 万例活产中产妇死亡率从 526 人降至 336 人，略有下降。在改善母婴和新生儿结局方面，利用医疗设施分娩是一个重要因素。然而，在乌干达，利用熟练接生员的概念并不普及。在 Masindi 地区，一项更早的干预措施旨在动员社区为母婴健康服务做出贡献，该措施发现移民人口使用产妇保健服务的比例低于当地人口。因此，这项定性研究的目的是更好地了解为什么移民人口使用产妇保健服务的比例较低，以及存在哪些障碍，以便提出可以促进公平获得产妇保健服务的干预措施。本研究采用了 5 次焦点小组讨论（3 次为女性；2 次为男性）、8 次与女性的深入访谈和 7 次与卫生工作者的关键知情人访谈，以更好地了解移民人口在母婴服务方面的经历。访谈和焦点小组讨论于 2016 年 7 月至 9 月进行。使用内容分析法和交叉性分析对数据进行分析。研究结果基于以下主题领域：基于族裔的歧视被视为获取服务的障碍、收入、教育和性别。移民人口认为他们受到歧视，因为他们无法用当地方言交流，他们是贫穷的临时工，或者教育程度不高。怀孕和分娩被认为是妇女的事情，而家庭的财务和其他决策则是男性的垄断。默默忍受分娩的痛苦被认为是英勇的行为。相比之下，在分娩开始时及早寻求护理会受到嘲笑，被认为是轻率的。在这种情况下，基于族裔的歧视、相互冲突的性别角色以及对默默忍受分娩痛苦的社会奖励交织在一起，导致移民妇女在获取产妇和新生儿护理方面面临障碍。我们建议建立平台，以消除有害的文化规范，并对卫生工作者进行基于 12 步安全和尊重母婴家庭护理的尊重性治疗的培训。
