Best practices for addressing socio-cultural barriers to reproductive, maternal and neonatal health service utilization among women from pastoralist communities of Afar, Ethiopia:A qualitative study

Background: Over the past decade, Ethiopia has shown impressive gains in improving access to reproductive, maternal and neonatal health services for its citizens, Nevertheless, there are striking disparities in the provision of good-quality reproductive, maternal and neonatal health services and the use of such services between regional states. In Afar region, which is home to numerous pastoralist communities, the uptake of reproductive, maternal and neonatal health services is particularly poor, largely due to socio-cultural barriers. However, there is limited scientific and context specific evidence on the best practices that could address the soico-cultural barriers to the uptake of such services in these pastoralist communities.Objective: To describe best practices to address the socio-cultural barrier to the uptake of reproductive, maternal and neonatal health services in the pastoralist communities of Afar, Ethiopia.Methods: This study used a qualitative approach with 12 respondents from Zone 1 of Afar region. Purposive sampling was used to recruit 12 health care providers to participate in the in-depth interviews, which were held between March and June 2016. All interviews were audio recorded and transcribed in English. Categories and codes were weighted for their significance to the research question and recurrence in the interviews. The transcripts were exported to ATLAS7.5.13 software for analysis. Recurring themes were described with accompanying explanatory quotes.Results: The best practices to address the prevailing socio-cultural barriers limiting the uptake of reproductive, maternal and neonatal health services in the Afar setting were identified as strengthening the traditional governance structure; forming volunteer groups and committees; constructive engagement of traditional birth attendants; promoting male involvement in reproductive, maternal and neonatal health services; engaging religious and clan leaders, and influential figures; making maternity waiting homes more culturally acceptable; improving postnatal care; promoting family planning; deploying mobile health teams and clinics; promoting community settlement; and setting priorities.Conclusions: Redirecting public resources to implement the best practices for an improved uptake of reproductive, maternal and neonatal health services needs to be considered in the context of 'development first', where women, education and infrastructural development are given priorities. Failing to appreciate the 'development first' approach will continue to perpetuate the low uptake of reproductive, maternal and neonatal health services and further widen the health disparities between the agrarian and pastoralist communities in Ethiopia.