Inequities in Continuum of Maternal, Neonatal and Child Healthcare Services Utilization in Rural Districts of Ethiopia

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: The “Continuum of Care” for maternal, newborn and child health (MNCH) includes integrated service delivery for mothers and children from pre-pregnancy to delivery, the immediate postnatal period, and childhood. It links interventions across sites of care, including home, community, and health facilities, and involves a variety of health providers. It is a cost effective strategy that increases uptake of MNCH services and provides opportunities for promoting related health care elements.

Methods: A study was conducted in December 2014 in four rural districts of Ethiopia to identify barriers to the continuum of MNCH care. The study used exploratory qualitative research methods mixed with an activity record from health facilities. We performed four FGDs with healthcare providers and community groups to assess the facilitating factors and barriers for a continuum of MNCH care and did focused group discussions and in-depth interviews (IDI) with different community groups and healthcare providers. IDIs were conducted with 25 women who have full packages of MNCH care and 20 women who discontinued MNCH care after having at least one contact with a health facility for MNCH services.

Results: The majority of women who discontinued receiving subsequent MNCH services after coming in contact for at least one MNCH service were young, unmarried, uneducated and those living far from health facilities and those perceived to be poor.

Conclusion: Poor and disenfranchised women at highest risk of poor MNCH outcomes were also those who were the least likely to continue services along the continuum of care. Improving the access and acceptability and promoting equitable MNCH services will be essential to ensure continuum of MNCH care and improve maternal and child health outcomes.