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Health Policy. 2019 Jan;123(1):87-95. doi: 10.1016/j.healthpol.2018.10.012. Epub 2018 Oct 25.

Barriers to accessing adequate maternal care in Latvia: A mixed-method study among women, providers and decision-makers.

Author information

1
Department of Health Services Research, CAPHRI, Maastricht University, Medical Center, Faculty of Health, Medicine and Life Sciences, Duboisdomein 30, P.O. Box 616, Maastricht, 6200 MD, the Netherlands. Electronic address: e.miteniece@maastrichtuniversity.nl.
2
Department of Health Services Research, CAPHRI, Maastricht University, Medical Center, Faculty of Health, Medicine and Life Sciences, Duboisdomein 30, P.O. Box 616, Maastricht, 6200 MD, the Netherlands. Electronic address: m.pavlova@maastrichtuniversity.nl.
3
European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom. Electronic address: Bernd.Rechel@lshtm.ac.uk.
4
Department of Obsterics and Gynecology, Riga Stradins University, Miera st 45, Riga, LV-1013, Latvia. Electronic address: dace.rezeberga@rsu.lv.
5
Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M.K. Čiurlionio g. 21, 03101, Vilnius, Lithuania. Electronic address: murauskiene@mtvc.lt.
6
Department of Health Services Research, CAPHRI, Maastricht University, Medical Center, Faculty of Health, Medicine and Life Sciences, Duboisdomein 30, P.O. Box 616, Maastricht, 6200 MD, the Netherlands; Top Institute Evidence-Based Education Research (TIER), Maastricht University, Kapoenstraat 2, 6211 KH, Maastricht, the Netherlands. Electronic address: w.groot@maastrichtuniversity.nl.

Abstract

INTRODUCTION:

Latvia has a high maternal mortality ratio compared to other European countries, as well as major inequities in accessing adequate maternal care. Adequacy refers to the extent to which services are safe, effective, timely, efficient, equitable and people-centred. This study aims to explore stakeholder views on access to adequate maternal care in Latvia and the extent to which there was consensus.

METHODS:

This mixed-method study is based on an online survey among women who recently gave birth, as well as interviews with healthcare providers and decision-makers. The data were analysed using the method of directed qualitative content analysis. The extent of stakeholder consensus was determined by studying five access-related aspects of maternal care: availability, adequacy, affordability, approachability and acceptability.

FINDINGS:

Our study identified barriers to accessing adequate maternal care related to availability (i.e. shortage of human resources, geographical distance) and appropriateness (i.e. inequalities in provider knowledge, care provision and use of clinical guidelines). Other challenges were related to providers' approaches towards women (i.e. communication) and, to a lesser extent, maternal care acceptance by women (i.e. health literacy).

CONCLUSIONS:

The barriers identified in our study highlight areas that should be addressed in future reforms of maternal care. These barriers also indicate the need for micro-level indicators that can facilitate a comprehensive evaluation of maternal care in Latvia and elsewhere.

KEYWORDS:

Access; Central and Eastern Europe; Latvia; Maternal care; Pregnancy; Quality

PMID:
30391120
DOI:
10.1016/j.healthpol.2018.10.012
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