Barriers to Maternal and Neonatal Healthcare in Cameroon: A Qualitative Study of Key Stakeholder for mMIST
Lily B Cooper1, Alfonsus Adrian Hadikusumo Harsono2,3, Comfort Enah4
1Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
Background:
Eliminating maternal and perinatal morbidity and mortality are global health priorities. Cameroon has some of the highest levels of maternal and neonatal mortality in the world. Evidence-based maternal healthcare is vital to ensuring women's and infants' health; however, offering such services in low-income countries is often challenging. Mobile health interventions have the potential to overcome longstanding public health barriers to fill gaps in maternal and infant care. This is among the first qualitative studies in Cameroon that examines individual and interpersonal barriers to maternity care to inform mHealth intervention adaptation.
Methods:
We conducted qualitative in-depth interviews (n=38) and three focus groups (n=18) with key stakeholders including previously pregnant women who experienced an adverse event, currently pregnant women, maternity care providers, healthcare administrators, and Ministry of Health representatives. Thematic analysis was performed using NVivo12 software. Themes were categorized on the individual and interpersonal levels. The current study is part of a larger, long-term implementation project to adapt MIST to the local contexts of Cameroon using mobile phones.
Results:
A total of 56 respondents, 14 men and 42 women, participated in this qualitative research. Participants reported individual-level barriers for women's timely and appropriate maternity care related to antenatal care initiation, antenatal care utilization, health literacy, and blind trust in providers. Participants suggested that women waited to initiate antenatal care, underutilized antenatal care, lacked perinatal health literacy, and trusted their providers, regardless of health outcomes and complications. At the interpersonal level, husbands, religious leaders, and family were identified by participants as influencing women's perinatal healthcare decisions-making, both positively and negatively.
Conclusion:
Our data reveal individual and interpersonal forces that affect maternal and perinatal care in Cameroon. Future public health efforts can focus on improving health literacy during pregnancy and reproductive years among women as well as in their close social networks.
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