“God gives the child”: An abductive analysis of barriers to postnatal care using the Health Equity Implementation Framework

Le résumé fourni par la source

Background: Postnatal care (PNC) is recommended as a means of preventing maternal mortality during the postpartum period, but many women in low- and middle-income countries do not access care during this period.Objective:We set out to examine sociocultural preferences that have been portrayed as barriers to care. Design: We designed a qualitative study using the Health Equity Implementation Framework (HEIF). Methods: We performed an abductive analysis of 63 semi-structured interviews with women who had recently given birth in three regions of Ethiopia using the HEIF and an inductive–deductive codebook to understand why women in Ethiopia do not use recommended PNC. Results: We found that, in many cases, health providers do not consider women’s cultural safety a primary need, but rather as a barrier to care. However, women’s perceived refusal to participate in postnatal visits was, for many, an expression of agency and assertion of their needs for cultural safety. Conclusion: We propose adding cultural safety to HEIF as a process outcome so that implementers consider cultural needs in a dynamic manner that does not ask patients to choose between meeting their cultural needs and receiving necessary health care during the postnatal period.

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