Barriers to appropriate care for mothers and infants during the perinatal period in rural Afghanistan: A qualitative assessment

Abstract

This study, conducted in five rural districts in Afghanistan, used qualitative methods to explore traditional practices of women, families and communities related to maternal and newborn care, and sociocultural and health system issues that create access barriers. The traditional practices discussed include delayed bathing of mothers and delayed breastfeeding of infants, seclusion of women after childbirth, restricted maternal diet, and use of traditional home remedies and self-medication instead of care in health facilities to treat maternal and newborn conditions. This study also looked at community support structures, transportation and care-seeking behaviour for maternal and newborn problems which create access barriers. Sociocultural barriers to better maternal-newborn health include shame about utilisation of maternal and neonatal services, women's inability to seek care without being accompanied by a male relative, and care-seeking from mullahs for serious health concerns. This study also found a high level of post-partum depression. Targeted and more effective behaviour-change communication programmes are needed. This study presents a set of behaviour-change messages to reduce maternal and newborn mortality associated with births occurring at home in rural communities. This study recommends using religious leaders, trained health workers, family health action groups and radio to disseminate these messages.

Keywords:

• maternal health services
• newborn care
• perinatal health
• health messages
• behaviour-change communication
• rural communities
• Afghanistan

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Acknowledgements

The authors gratefully acknowledge the important contributions of Janneke Roos and Paul Ickx in various elements of the design and field implementation of this study. The work that was the basis for this article was supported by funding from the US Agency for International Development under the BASICS (Basic Support for Institutionalizing Child Survival) Afghanistan Project, managed by Management Sciences for Health, contract number GHA-I-00-04-00002-00.