Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug 13;18(1):631.
doi: 10.1186/s12913-018-3432-z.

Barriers to accessing adequate maternal care in Georgia: a qualitative study

Elina Miteniece  1 , Milena Pavlova  2 , Lela Shengelia  3 , Bernd Rechel  4 , Wim Groot  2   5
Affiliations

Barriers to accessing adequate maternal care in Georgia: a qualitative study

Elina Miteniece et al. BMC Health Serv Res. .

Abstract

Background: The maternal health outcomes in Georgia are linked to shortcomings in healthcare such as inequities in access to adequate maternal care. Due to the macro-level, quantitative approach applied in most previous studies, little is known about the underlying reasons that influence maternal care and care-seeking behaviour of pregnant women.

Methods: This qualitative study explores the stakeholders' perspectives on access to adequate maternal care in Georgia. Focus-group discussions are conducted with mothers who gave birth within in the past four years and in-depth interviews are conducted with decision-makers and health professionals in the field. Five access-related aspects are studied: availability, appropriateness, affordability, approachability and acceptability of maternal care. The method of direct content analysis is applied.

Results: Results indicate problems with maternal care standards, inequalities across population groups and drawbacks in maternal care financing. This includes gaps in clinical quality and staff skills, as well as poor communication between women and health professionals. Geographical barriers to adequate maternal care exist in rural and mountainous areas due to the weak infrastructure (poor roads and weak transportation), in addition to financial hardships. Despite improvements in the coverage of maternal care, affordability remains an access barrier. Poorer population groups are financially unprotected from the high out-of-pocket payments for maternal care services.

Conclusion: These findings imply that micro-level indicators, such as disrespectful behaviour of health professionals and affordability of care, should be taken into account when assessing maternal care provision in Georgia. It should complement the existing macro-level indicators for a comprehensive evaluation of maternal care.

Keywords: Access; Approachability; Appropriateness; Cost; Georgia, Central and Eastern Europe; Maternal care; Pregnancy.

PubMed Disclaimer

Conflict of interest statement

Ethical approval of the study was obtained from the Bioethical Committee of the National Center for Disease Control and Public Health of Georgia prior to data collection in April, 2015.

Every participant gave a consent before taking part in this study. Focus group discussion participants gave an oral consent while in-depth interview participants provided a written consent.

Not applicable

Dr. Milena Pavlova acts as a Section Editor for BMC Health Services Research.

The authors declare that they have no competing interests.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Barriers to access to adequate maternal care. Source: Authors’ compilation, based on Levesque et al. [19]
See this image and copyright information in PMC

References

    1. World Health Organization . Trends in maternal mortality: 1990–2015: estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary. 2015.
    1. Hill K, Thomas K, AbouZahr C, Walker N, Say L, Inoue M, Suzuki E, Group MMW Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data. Lancet. 2007;370(9595):1311–1319. doi: 10.1016/S0140-6736(07)61572-4. - DOI - PubMed
    1. National Centre for Disease Control and Public Health . Reproductive health survey Georgia 2010. Tbilisi: National Centre for Disease Control and Public Health; 2012. pp. 1–349.
    1. Chanturidze T, Ugulava T, Durán A, Ensor T, Richardson E. Georgia health system review. Health Syst Transit. 2009;11(8):1–116.
    1. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387(10017):462–474. doi: 10.1016/S0140-6736(15)00838-7. - DOI - PMC - PubMed

LinkOut - more resources