Maternal health service utilization in urban slums of selected towns in Ethiopia: Qualitative study

Abstract Introduction: Although Ethiopia is one of the least urbanized countries in the world, the pace at which urbanization increases is unprecedented. During the last twenty years, urbanization has expanded rapidly and is estimated to be at 38% in 2050 from the current proportion of 19%. Despite the fact that urbanization is associated with relatively, better access to social services including health, residents in urban setting are believed to suffer from health disparities in health indicators such as use of Antenatal care (ANC), institutional delivery and postpartum care (PNC). This study aims to identify reasons why urban women fail to use available maternal health services in selected urban settings in Ethiopia. Methods: A qualitative study using focus group discussions and in-depth interview was conducted in six purposively selected urban settings such as Adama, Dire Dawa, Hawassa, Debre Berhan, Gondar, and Mekelle. A total of 11 Focus Group Discussions and 40 in-depth-interviews were completed with residents of these urban settings who were living in the section of urban setting characterized as slum. The data collected were categorized in to themes and analyzed using thematic method. Results: Study participants anonymously argued that there are positive changes in maternal health service utilization in all study settings over the years. However, students, daily laborers, widows, divorced and separated women, commercial sex workers, house maids, and migrants were found to be reluctant in using maternal health services such ANC follow-up, institutional delivery and PNC. Reasons were found to be attributed to individual characteristics, perceived capacities of health facilities and friendliness of service providers and socio-cultural factors including socially sanctioned expectations at community level in connection with pregnancy, delivery and postpartum. Conclusion: Although service utilization in urban setting is believed to have been relatively better over the years, still women in urban settings do not use available maternal health services. Especially women living in slum areas tend to neglect use of available health services. This study suggests that blanket programmatic approach should give way to intervention that target specific section of population. Furthermore, programs are expected to be tailored to addresses individual, institutional and socio-cultural factors in tandem to improve maternal health service utilization in urban setting. [Ethiop. J. Health Dev. 2017;31(2):96-102] Key words: Maternal Health Services, Urban Health, Social Determinant of Health, Ethiopia