Table 1.

Barriers to uptake and provision of maternal health services

Provision barriers	Uptake barriers
Geographic accessibility
Travel restrictions35 Lack of ambulances27 30	Quarantine and travel restrictions33 35
Availability
Insufficient staffing (absenteeism, abandonment, transfer and/or death related to EVD)21 23 24 27 30–32 36 Unqualified, traditional HCWs3 30 31 33–35 Facility closures, reduced hours3 22–24 27 28 34 35 Waiting time increased with EVD testing23 27 29 32 Resource diversion and scarcity3 20 23 24 26 28 30 31 35 36 EVD screening difficulties23 28 32 Exclusion of pregnant women from services27 31 34 MHS reduced, suspended, discontinued or unavailable13 23 24 26–31 34 35 Late or no referral27 HCW fear of EVD3 20 24–31 35 36 Absent, insufficient or delayed training on EVD and infection control3 20 24–26 30 31 35 Clinical guidelines absent, unclear, impractical29 Lapse of support to traditional birth attendants and community health workers for MHS referrals35	Rumours regarding EVD and the intentions of HCWs and other EVD responders3 24–30 32 35 36
Affordability
Informal fees31 Shift from public to private facilities due to fear of EVD in the public sector3
Acceptability
Rumours that MHS are no longer free27 Staff mistrust of pregnant women27 Worsened interpersonal skills among HCWs31	Community fear and/or mistrust of facility-based HCWs and health facilities3 24–28 30–36 Preference for/increased traditional, community-based care3 30 31 33–35 Stigmatisation of HCWs, pregnant women and EVD20 24 29 31 33 No touch policy27 31 35

Source: Adapted theoretical framework.¹⁵

EVD, Ebola virus disease; HCW, healthcare worker; MHS, maternal health services.