Wars affect maternal health services by destroying health systems. Eritrea experienced two wars with neighbouring Ethiopia. Despite this, the maternal mortality ratio (MMR) in Eritrea fell by 69% from 1590 per 100,000 live births in 1990 to 501 in 2015. This study aimed to examine facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea.
Using in-depth interviews and field observations for data collection, this qualitative study was conducted in five healthcare facilities in Asmara, the capital of Eritrea, in February and March 2016. The participants were: women (n = 40), husbands (n = 5), healthcare providers (n = 10), and decision makers (n = 5).
There were two perceived facilitators of utilisation of and access to maternal health services: health education (related to the WHO health service delivery building blocks) and improvement in gender equality driven by the role played by Eritrean women as combatants during the War of Independence (1961–1991). The only perceived barrier was poor quality of care due to lack of ultrasound machines, short clinic opening hours, and shortage of healthcare workers (related to the WHO health workforce building block).
This study assessed women and their husbands/partners’ perceptions and the possible effects of contemporary Eritrean culture and the history of war on the utilisation of and access to maternal health services in the country. As well, we examined healthcare providers’ and decision makers’ perspectives. The two key facilitators of women’s utilisation of and access to maternal health services were health education and women’s empowerment driven by their role as combatants during the War of Independence. One main barrier was poor quality of care due to lack of ultrasound machines, short clinic opening hours, and a shortage of healthcare workers. As only a limited number of qualitative studies have been published about maternal health services in war-affected sub-Saharan African countries, our findings regarding health education and women’s empowerment could be considered in other war-affected countries similar to Eritrea. Nevertheless, further research is needed to investigate our findings – particularly regarding female empowerment driven by women’s role in combat in relation to their maternal health.
World Health Organization. The world health report 2000. Health systems: improving performance. Geneva: WHO; 2000.
Strand H, Wilhelmsen L, Gleditsch N, International Peace Research Institute Oslo (PRIO). Armed conflict dataset codebook. Uppsala: PRIO; 2003.
Themnér L, Wallensteen P. Armed conflicts, 1946–2011. J Peace Res. 2012;49(4):565–75. CrossRef
WHO, UNICEF, UNFPA, The World Bank, United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Geneva: WHO; 2015.
Murphy SD, editor The Eritrean-Ethiopian War (1998-2000). The Eritrean-Ethiopian war (1998–2000). George Washington University Legal Studies Conference. Washington, DC: Oxford University Press; 2016.
Bernal V. Eritrea goes global: reflections on nationalism in a transnational era. Cult Anthropol. 2004;19(1):3–25. CrossRef
World Health Organization. Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer. Geneva: WHO; 2004.
The United Nations. Women's anti-discrimination committee takes-up report of Eritrea; told gender equality efforts hindered by stereotypes, poverty, war. New York: UN; 2006.
The State of Eritrea Ministry of Health. Eritrea annual health service activity report of year 2012. Asmara: Eritrea Ministry of Health; 2013.
UNDP. Innovations driving health MDGs in Eritrea. UNDP Eritrea: Asmara; 2014.
The State of Eritrea Ministry of Health. National health policy. Asmara: Eritrea Ministry of Health; 2010.
Holzgreve W, Greiner D, Schwidtal P. Maternal mortality in Eritrea: improvements associated with centralization of obstetric services. Int J Gynecol Obstet. 2012;119(SUPPL.1):S50–S4. CrossRef
World Health Organization. World health statistics 2015. Geneva: WHO; 2015.
The State of Eritrea Ministry of Health, ORC Macro. Eritrea Demographic and Health Survey 2002. Asmara: Eritrea Ministry of Health, Bureau of Statistics, and Calverton, MD, USA: ORC Macro; 2002.
The State of Eritrea National Statistics Office (NSO), Fafo Institute for Applied International Studies (AIS). Eritrea Population and Health Survey 2010. Eritrea population and health survey 2010. Asmara: Eritrea Ministry of Health; 2013.
Mugo N, Dibley M, Agho K. Prevalence and risk factors for non-use of antenatal care visits: analysis of the 2010 South Sudan household survey. BMC Pregnancy Childbirth. 2015;15(1):68.
The State of Eritrea Ministry of Health. Second national integrated monitoring and evaluation framework 2012–2016. Asmara: Eritrea Ministry of Health; 2012.
Bowling A. Research methods in health: investigating health and health services. Maidenhead: McGraw-Hill Education; 2014.
World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva: WHO; 2010.
Langer A, Meleis A, Knaul FM, Atun R, Aran M, Arreola-Ornelas H, et al. Women and health: the key for sustainable development. Lancet. 2015; https://doi.org/10.1016/S0140-6736(15)60497-4.
Sidel V, Levy B. The health impact of war. Int J Inj Control Saf Promot. 2008;15(4):189–95. CrossRef
Kawulich BB. Participant observation as a data collection method. Qualitative forum: qualitative social research; 2005. https://doi.org/10.17169/fqs-6.2.466.
Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27(2):237–46. CrossRef
El-Jardali F, Adam T, Ataya N, Jamal D, Jaafar M. Constraints to applying systems thinking concepts in health systems: a regional perspective from surveying stakeholders in eastern Mediterranean countries. Int J Health Policy Manage. 2014;3(7):399–407. CrossRef
Miles MB, Huberman AM. Qualitative data analysis: a sourcebook of new methods. California: Sage Publications; 1984. Report No: 0803922744; 9780803922747
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. CrossRef
Howard-Grabman L, Snetro G. How to mobilize communities for health and social change. Maryland: Management Science for Health; 2003.
World Health Organization. Ottawa charter for health promotion. Geneva: WHO; 1986.
The United Nations. Implementation of the Beijing platform for action and the outcome douments of the twenty-third special session of the general assembly. New York: UN; 2004.
Elborgh-Woytek K, Newiak M, Kochhar K, Fabrizio S, Kpodar K, Wingender P, et al. Women, work, and the economy: macroeconomic gains from gender equity. IMF Staff Discussion. Washington DC: IMF; 2010.
The World Bank. Labor force participation rate. Washington DC: World Bank; 2016.
Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry. 1988;25(1):25–36. PubMed
- Stakeholders’ perspectives on facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea: a qualitative study
Robert G. Cumming
- BioMed Central
Neu im Fachgebiet Gynäkologie und Geburtshilfe
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II