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

Abstract: 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.