Informal Healthcare Provision and Maternal Health: A Comparative Study of Urban Egypt,

In many urban African settings, formal healthcare systems are supplemented by a significant informal sector. In Egypt, informal providers such as pharmacists, traditional healers, and unlicensed practitioners are a common first point of contact for women, but their specific role in maternal healthcare is not well documented. This study compared the utilisation, perceived roles, and impacts of informal healthcare providers on maternal health in urban Egypt. It aimed to identify key drivers for seeking informal care and to contrast these patterns with the use of formal obstetric services. A comparative qualitative study was conducted using semi-structured interviews and focus group discussions. Participants included postpartum women, informal healthcare providers, and formal sector midwives and doctors from two major urban governorates. Data were analysed using a thematic framework approach. A prominent finding was the preference for informal pharmacists for initial pregnancy-related consultations, cited by a substantial proportion of women, primarily due to perceived convenience, lower cost, and confidentiality. This was contrasted with a reliance on formal sector care for later-stage pregnancy monitoring and delivery, though financial constraints often delayed this transition, creating a disjointed care pathway. The informal healthcare sector acts as a critical, yet complementary, gateway to maternal health services in urban Egypt. Its current integration with formal care pathways is suboptimal, leading to fragmented care. Policy should focus on developing regulatory frameworks for informal providers, particularly pharmacists, and explore structured linkage and referral systems to formal antenatal care. Public health campaigns should educate women on the limitations of informal care for comprehensive obstetric management. Informal healthcare, maternal health, urban health, Egypt, qualitative research, health-seeking behaviour, comparative study This study provides a nuanced comparative analysis of the informal healthcare sector's role in urban Egyptian maternal health, highlighting its function as a primary access point and the implications of its disconnect from formal services.