- Title
- Examining access to health services for women of reproductive age from ethnic communities in Chittagong Hill Tracts (CHT) of Bangladesh
- Creator
- Akter, Shahinoor
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2020
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: During the Millennium Development Goal era, Bangladesh significantly improved maternal health outcomes. However, maternal health data on Indigenous women in the Chittagong Hill Tracts (CHT) is not available and limited evidence suggests that maternal health outcomes for these women have not improved in line with their non-Indigenous peers. This thesis investigates maternal health care (MHC) service access, satisfaction, and experiences among Indigenous women in the CHT, Bangladesh. Methods: To undertake this investigation a sequential mixed-methods design, comprising a population-based cross-sectional survey and qualitative interviews, was informed by an integrative literature review of MHC service utilisation among Indigenous women in lower and middle-income countries. Indigenous women aged 15 to 49 years from Chakma, Marma and Tripura communities, within three years of delivery, were invited to participate in the study. Knowledge about, and prevalence of access to, Ante-Natal Care (ANC), facility delivery and Post-Natal Care (PNC) services were estimated. Factors associated with knowledge, access and satisfaction with care were determined using multivariable logistic regression, adjusted for clustering by village. In-depth interviews with 21 Indigenous women, using qualitative description techniques and with eight key informants (Indigenous community leaders and health care providers) using an ethnographic approach were conducted to explore experiences accessing MHC services. Qualitative data were analysed thematically. Findings from these mixed methods were integrated to formulate policy and practice recommendations and future research. Results: From a total of 494 Indigenous women across two sub-districts, 438 participated in the survey (mean age 25 years, 89% response rate). Survey data revealed the estimated prevalence of knowing about ANC, facility delivery and PNC were 69%, 73%, and 16.4% respectively. Independent factors associated with knowing about ANC services, in order of effect size, were higher education, knowledge about nearest facilities, higher household income and older age. Independent factors associated with knowing about facility delivery were knowledge about nearest facilities; higher household income and attending ANC. Women involved in income generating activities had significantly reduced odds of knowing about delivery services. Factors independently associated with knowing about PNC services were delivery at a facility, knowledge of childbirth complications, access to media and Marma ethnicity. Prevalence of access to any MHC, ANC, delivery and PNC service were estimated at 59%, 53%, 33% and 9.8% respectively. Independent factors associated with accessing any MHC service in order of effect size, were knowledge of nearest facilities, knowledge of pregnancy-related complications, education and number of pregnancies. Independent factors associated with accessing ANC services, were knowledge about ANC benefits, place of residence and higher household income. Independent factors associated with accessing facility delivery were attending ANC, access to media, partner’s level of education and place of residence. Factors independently associated with accessing PNC services were knowledge of PNC benefits and older age. Descriptive analyses of survey data revealed that CHT Indigenous women were satisfied overall with interpersonal relationships with healthcare providers and with communication in their native language. Maintenance of personal privacy was the key independent factor associated with satisfaction of ANC services. Qualitative findings revealed that Indigenous women were not satisfied with MHC services because personal privacy at childbirth was not maintained and because of limited access to health professionals and essential resources at facilities. Interview data revealed that CHT Indigenous women lacked knowledge about freely available, low-cost services within their communities and they mostly accessed MHC services for pregnancy-related complications that were unmanageable at home. Abusive and unprofessional behaviour from staff at public facilities, including Indigenous staff, discouraged women from accessing services. Key informants reported that distance and inadequate resources constrained healthcare providers’ opportunities to provide services. They also reported there was little engagement with communities to inform the design of health programs, thus creating culturally unfriendly environments. Discussion: Access to MHC services was lower among Indigenous women from CHT communities than the national average. CHT Indigenous women experienced discrimination by health staff including Indigenous health staff at public facilities. Absence of community-engagement in the health programs gave limited opportunities for Indigenous women to have their voices heard. Not using Indigenous native language may have limited participation and the cross-sectional design did not allow temporal sequence to be determined and is subject to recall bias and social desirability bias. The small sample of qualitative interviews limits transferability of results and may have been subject to participation bias. Conclusion: Lower access to maternal healthcare services among Indigenous CHT women is associated with a lack of knowledge about services and culturally unfriendly environments. Knowledge about nearest health facilities, pregnancy, and childbirth complications and providing culturally appropriate health systems may improve MHC access for Indigenous women. Community engagement and context-specific interventions are needed to improve maternal health outcomes for Indigenous women and their children.
- Subject
- Indigenous women; access; maternal health care services; maternal Health; mixed method study; Bangladesh; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1421986
- Identifier
- uon:37791
- Rights
- Copyright 2020 Shahinoor Akter
- Language
- eng
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