Table 1.
Barriers to utilisation of skilled delivery services in Moroto and Napak districts, Uganda
| Barrier | Findings |
|---|---|
| I. Socio-cultural factors | |
| Beliefs and practices | Cowards deliver at health units, beliefs related to disposal of placenta; cutting and tying of umbilical cord and expressing fear during delivery, delivering position, delivery is a private family issue, the ceremony of showing the baby to the public, the ceremony of naming a child, administration of traditional herbs |
| The role of men | Perceive maternal health as a women’s issue. Men are less emotionally and practically involved in maternal health |
| Women’s domestic chores | Nobody to prepare food at home and take care of children left behind while the woman is admitted |
| II. Perceived benefit/need | |
| Lack of knowledge | Lack on information about benefits of delivering in health units, low education status of women, lack of health education |
| Infrastructure, drugs and supplies | Lack of beds; light at night; drugs; supplies; equipment and water. Facilities not equipped to handle complications, few staffs to attend to women, long waiting time |
| Shortage of staff | |
| Perceived quality of care | |
| Bad staff attitude | Disrespectful staff, staff coming to work drunk or late, poor relationships between community and health staff, harsh treatment during delivery |
| Role of the TBAs | TBAs are acceptable, accessible, and affordable and offer a range of services. Confidence in trained TBAs. Women don’t deliver at health facilities unless they have been referred by TBAs. |
| Lack of involvement | Community not consulted about where to build health facilities, lack of information about facility catchment areas |
| III. Economic inaccessibility | |
| Lack of income | Poverty, costs of drugs and supplies, cost of ambulance, transportation costs |
| Lack for food at home | Lack of food at home for the family |
| Lack of food at health facilities | Lack of food for women delivering in health facilities and their caretakers |
| User fees | User fees at some health facilities |
| IV. Physical inaccessibility | |
| Insecurity | Inter-clan feuds and cattle rustling, insecurity at night, fear of the military |
| Distance/bad terrain | Long distance to health facilities, bad terrains, flooding of river valleys and muddy roads during rainy seasons |
| Lack of transportation means | Lack of reliable means of transportation even if women had money to pay for transportation |