Many countries have been making progress on improving the availability and provision of skilled maternity care, but this hasn’t always resulted in more women using them. Why not?
Cultural issues can often influence women’s use of maternity care services, either leading women to avoid services or to seek them. It is important to recognise any differences in cultures between service users and service providers if the use of skilled maternity care services is to improve. Our recent research shows that many different interventions have been tried.
In our research, we wanted to understand the nature and range of interventions that address cultural factor as a way to improve women’s use of skilled maternity care services. To do this we conducted a systematic mapping of the literature. Our search generated over 30,000 articles, all of which we screened. The end result was an inventory of 96 papers which included interventions from 35 countries. The need for ‘culturally-appropriate’ health facilities, core to the World Health Organization’s mandate on ‘health for all’ and its strategy for improving maternal and newborn health, has evidently been recognised around the world. However, the large majority of what we found was from high-income countries and targeted specific sub-populations, like immigrant, ethnic minority groups or Aboriginal communities.
What we found
Given that the cultural factors that affect use of skilled maternity care are context-specific, we developed five intervention categories:
- service delivery models
- service provider interventions
- health education interventions
- participatory approaches
- mental health interventions
Most of the African studies were community mobilisation interventions, i.e participatory and health education interventions. From narrative descriptions of interventions to studies evaluating impact through the use of randomised controlled trials, the inventory items clearly reflect great differences in levels of evidence.
We found that evidence is lacking on the effectiveness of these interventions. Only a minority of the studies had designs which could provide strong evidence of the impact of an intervention. Whilst much of the identified literature states a clear aim to address cultural factors, studies often provide insufficient detail about how exactly the interventions addressed these cultural factors. Given that ‘culture’ is a complex concept with varied definitions and usages in the literature, this finding is perhaps unsurprising.
We already know culture cannot be ignored if we want women to be satisfied with and use maternity care services. To better understand the impact of culturally-appropriate skilled maternity care on maternal and newborn health outcomes, we are finalising a systematic review of interventions. Together with the systematic mapping, we hope that these resources will provide a rich resource of information for researchers, programmers, and policymakers seeking to deliver more culturally appropriate, responsive, and effective maternity care services to populations.
To read this article click here
To read a summary of the studies included in the inventory that occured in MamaYe Evidence for Action countries, click here.