Khan Bushra Asif Ali, Mahmood Humaira, Ahmed Jawaria Mukhtar, Anwar Bushra, Muhammad Ameer, Jabeen Rawshan
National University of Medical Sciences (NUMS), Rawalpindi, Pakistan.
Public Health, NUMS, Rawalpindi, Pakistan.
BMC Health Serv Res. 2025 Apr 1;25(1):482. doi: 10.1186/s12913-024-11637-1.
Maternal and newborn mortality are critical global health concerns. Achieving Sustainable Development Goal 3.8 (SDGs), which aims to improve these outcomes, is hindered by the poor quality of care in health facilities, a significant barrier to the utilization of antenatal care (ANC) services in Pakistan. This study aimed to explore the barriers to the underutilization of ANC services in Tehsil (sub-division of a district) Hazro, Punjab, Pakistan, from the perspective of pregnant women.
The study employed four focus group discussions (FGDs) with 36 pregnant women who had attended at least three ANC visits. Data were collected through purposive sampling and analyzed using NVivo 12, ensuring rigor through Lincoln and Guba's guiding principles.
The findings revealed three key themes, following the three delays model: 1. Decision to Seek Care, 2. Delay in Reaching Healthcare Facilities, and 3. Delay in Acquiring Satisfactory and Appropriate Health Care. Women often made the decision to seek care with the support of their spouse, family, and lady health workers, highlighting the importance of their decision-making autonomy. Financial constraints did not significantly hinder access to healthcare services. However, long distances, travel time, and associated costs were identified as major barriers. Most importantly, the majority of women lacked awareness of danger signs and the importance of seeking timely medical help. This issue was compounded by the unavailability of healthcare personnel, negative staff attitudes, insufficient medicines and equipment, and a lack of referral services.
This descriptive study underscores the urgent need for affordable, accessible, and responsive maternal and child healthcare. To address these barriers, stakeholders - including policymakers, public health experts, and maternal, neonatal, and child health (MNCH) providers - must prioritize MNCH initiatives and reforms. Collaborative efforts are crucial to translating MNCH policies into effective strategies at the community level.
孕产妇和新生儿死亡率是全球关键的卫生问题。实现可持续发展目标3.8（SDGs）旨在改善这些结果，但卫生设施护理质量差成为阻碍，这也是巴基斯坦产前护理（ANC）服务利用率的一个重大障碍。本研究旨在从孕妇的角度探讨巴基斯坦旁遮普省哈兹罗乡（县的分区）ANC服务利用不足的障碍。
该研究与36名至少进行过三次ANC就诊的孕妇进行了四次焦点小组讨论（FGD）。通过目的抽样收集数据，并使用NVivo 12进行分析，依据林肯和古巴的指导原则确保严谨性。
研究结果遵循三个延误模型揭示了三个关键主题：1. 寻求护理的决定；2. 到达医疗机构的延误；3. 获得满意和适当医疗护理的延误。女性通常在配偶、家人和女性卫生工作者的支持下做出寻求护理的决定，凸显了她们决策自主权的重要性。经济限制并未显著阻碍获得医疗服务。然而，路途遥远、出行时间和相关费用被确定为主要障碍。最重要的是，大多数女性缺乏对危险信号以及及时寻求医疗帮助重要性的认识。医疗人员短缺、工作人员态度消极、药品和设备不足以及缺乏转诊服务使这一问题更加严重。
这项描述性研究强调了迫切需要提供负担得起、可及且反应迅速的母婴保健服务。为解决这些障碍，包括政策制定者、公共卫生专家以及孕产妇、新生儿和儿童健康（MNCH）提供者在内的利益相关者必须优先考虑MNCH倡议和改革。合作努力对于将MNCH政策转化为社区层面的有效战略至关重要。
