A qualitative study of barriers to access and use of pre-paid postnatal care services among mothers under the reproductive health voucher system in rural Uganda

Background: The first six weeks following a delivery is a critical period for the mother and the newborn. Despite removing out-of-pocket fees at a postnatal care access point in some parts of Uganda, few mothers utilize pre-paid services. Data from a health facility providing pre-paid postnatal care services in rural Eastern Uganda, revealed that only 17.9% of the mothers came back for postnatal care despite the services being free. This study therefore sought to explore and gain a deeper understanding of the barriers contributing to the low turn-up of voucher registered women from using pre-paid postnatal care services. Methods: A qualitative study design was applied, and 10 in-depth interviews with mothers under the pre-paid postnatal care voucher system were conducted in the district of Luuka, Eastern Uganda in January 2018. Data were analyzed through qualitative manifest and latent content analysis. Results: Four themes were developed through the analysis: a wanting healthcare system theme revolved around the narrow perceptions about postnatal care services and previous unpleasant experiences of health facilities. Fighting to meet social expectations emerged from experiences of how gender roles for women and social norms in communities negatively affected mothers’ ability to utilize postnatal care services. Leaning on cultural customs and religious beliefs described traditional treatment options and values that were obstacles to seeking health facility-based care. Suffering with ineffective communication talks about receiving sketchy information and corruption rumors. Conclusion: Insufficient information and understanding of postnatal care services was a major barrier to utilization of services. Many health workers in the maternal and child health section did not speak the local language well. This suggests a possibility that health messages were not being understood by mothers. Service providers should utilize services like antenatal care to provide accurate information and build options for receiving feedback as regards their health services.Postnatal care services are essential in preventing ill-health and death related to childbirth within the first year of a child’s life. Globally, most deaths of mothers and their newborn babies occur during the first month after giving birth and half of those deaths happen within the first 24 hours after delivery. Severe and uncontrolled bleeding, infections and complications are the major cause of these deaths and ill-health. In Uganda, 336 deaths occur in every 100,000 live births and this is one of the highest figures in the world. Despite cutting off fees paid at the counter for postnatal services in some parts of Uganda, very few mothers utilize these pre-paid services. Data from a health center providing pre-paid postnatal care services in the rural Eastern Uganda revealed that only 17.9% of the mothers came back for pre-paid postnatal care services. The main aim of this study was to find out the reasons that bar mothers from using pre-paid postnatal care services. The study results reveal there are gaps in the healthcare set-up including a lack of access by mothers to information about services they can use after giving birth. Mothers also do not understand what goes on while health workers perform certain medical procedures. There are also social and gender norms and expectations of being a woman which puts mothers in a difficult situation to seek and use postnatal services. And lastly, mothers did not seem portray the correct description of postnatal services such as time frames and details as assumably being told by service providers. From these findings, the researcher concluded that there was a lack of understanding and importance of postnatal care; inaccurate information and socioeconomic barriers with gender bias. The author recommended that creating and using communication platforms that enable back-and-forth flow of information at health facilities and in communities would help overcome some of the barriers