Mastylak Alicja, Miteniece Elina, Czabanowska Katarzyna, Pavlova Milena, Groot Wim
Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
Research Center for Midwifery Science, Academic Verloskunde Maastricht, Zuyd, the Netherlands.
Midwifery. 2023 Jan;116:103554. doi: 10.1016/j.midw.2022.103554. Epub 2022 Nov 12.
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.
A mixed-methods study.
Online survey and online semi-structured interviews conducted between March 2021 and May 2021.
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.
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.
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.
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.
所有女性都应能获得充分且受尊重的孕产妇保健服务，以实现最佳健康 outcomes。在波兰，良好的孕产妇健康指标与糟糕的护理体验之间存在不匹配。本研究从可及性、适宜性、可负担性、易接近性和可接受性方面，考察了利益相关者对波兰充分孕产妇保健服务可及性的看法。
一项混合方法研究。
2021年3月至2021年5月期间进行了在线调查和在线半结构化访谈。
557名最近在波兰分娩的女性、孕产妇保健服务提供者以及活跃于孕产妇健康领域的决策者。
获得充分护理的主要障碍包括孕产妇保健服务提供者沟通不当、未充分遵守护理标准、分娩过度医疗化以及女性在护理提供过程中的参与度欠佳, 以及孕产妇保健服务的自付费用水平较高。其他障碍包括孕产妇保健服务提供者尤其是助产士数量有限，以及女性生殖健康素养较低。
尽管近年来在护理提供方面取得了显著进展，但提供充分且以女性为中心的孕产妇保健服务仍然不稳定。消除这些障碍可大幅改善波兰充分孕产妇保健服务的体验和可及性。
调查中发现的女性面临的障碍与访谈中强调的障碍基本一致, 此外，孕产妇保健服务提供者和决策者提供了有关孕产妇保健系统现状的具体背景信息和解释,因此，本研究为波兰以及其他在充分提供孕产妇保健服务方面存在类似缺陷的中欧和东欧国家的政策和实践提供了方向指引信息。
