Exploring barriers and facilitators of maternal health service utilisation in the Sidama region, Ethiopia: perspectives of women and stakeholders

Women in low-income countries such as Ethiopia face multiple challenges in accessing maternal health services. This study aimed to explore factors influencing maternal health service use in the Sidama region, Ethiopia, from the perspectives of women and stakeholders, including healthcare providers, maternal health experts, and traditional birth attendants (TBAs). Eight focus group discussions (FGDs) were conducted with women using a maximum variation purposive sampling approach, ensuring broad representation across age groups, education levels, areas of residence, and histories of uptake of maternal health services. In-depth interviews were conducted with health extension workers (HEWs) and TBAs to gather and validate information from the women’s closest maternal health services providers through primary health services and traditional practices, respectively. A roundtable discussion was also held with midwives, clinicians, government officials, and researchers to capture broader stakeholder perspectives. An exploratory qualitative approach was employed to gain an in-depth understanding of the attributes of maternal health services from different perspectives. We adapted the Donabedian model of healthcare quality, which comprises the structure, process, and outcome domains, and incorporated demand-side barriers to organise the themes that emerged from our data. A total of 61 participants, including 48 reproductive-age women, 4 TBAs, 3 HEWs, and six maternal health experts, participated in this study. Factors constraining women’s utilisation of maternal health services included structural barriers, such as health system accessibility, infrastructure, and service costs; process-related barriers, such as healthcare providers’ attitudes and competence, and service efficiency; and outcome-related barriers, including prior treatment experiences, women’s perceptions of service quality, and referral systems. Moreover, demand-side barriers, such as socio-cultural and religious beliefs, family decision-making, and women’s domestic responsibilities, play a crucial role. This study highlights that multiple factors influence women’s utilisation of maternal health services in the Sidama region, Ethiopia. Addressing factors such as health service accessibility, efficiency, and the provision of compassionate, respectful, and affordable care can help design responsive interventions to improve maternal health service utilisation in resource-limited settings. It is recommended that policymakers prioritise interventions that address barriers to maternal health service use.