Barriers to the Provision and Utilization of Reproductive Health Services in Côte d'Ivoire

ABSTRACT: Reproductive, maternal, newborn, child, adolescent and nutrition health (RMNCAH+N) services play a key role in public health in Côte d'Ivoire, aiming to improve the well-being of women, children and adolescents through effective and accessible interventions. However, significant barriers remain in their supply and use, particularly in the Bagoué, Gontougo and Cavally regions. This study aimed to identify the factors limiting the access and effectiveness of RMNCAH+N services in these regions, while proposing solutions adapted to the local socio cultural, economic and geographical specificities. The research, carried out between 6 and 12 September 2021, was based on data from the 2016 DHS and MICS surveys, highlighting five areas with weak indicators. Three regions (North, Northeast, West) were selected for their ethnocultural diversity in order to explore socio-cultural dynamics. Using a qualitative approach, the study involved 45 interviews and 67 focus groups involving central and regional leaders, health care providers, and the community, analyzed using NVIVO 14. The results show that the lack of a specific legislative framework, the non-application of health standards, and the underfunding of care are slowing down progress. In addition, inadequate infrastructure and equipment, misperceptions about health, and socio-cultural barriers, such as women's dependence on their husbands, aggravate the situation. This study highlights the urgency of structural and adapted solutions to improve access to and quality of RMNCA+N services in Côte d'Ivoire.