Barriers and strategies to accessing maternal and child health services: an explorative qualitative study of women’s experiences during the COVID-19 pandemic in Entebbe Municipality, Uganda

The COVID – 19 pandemic created unprecedented challenges for healthcare-seeking worldwide. However, little is known about how women accessed maternal and child health care (MCHC) services in resource – limited settings like Uganda during this period. This study therefore qualitatively explored how the COVID – 19 pandemic affected women’s access to antenatal, delivery, postnatal, and child health services in Entebbe Municipality. We conducted a total of 28 in – depth interviews in 2023. Women were purposively selected for the study. A semi-structured interview guide and a voice recorder were used to collect data, which was done repeatedly until data saturation was reached. Data analysis was performed using QRS International NVivo 12 software. Data analyses were conducted using an inductive thematic analysis approach. The study identified two overarching themes: obstacles to accessing maternal and child health care and perceived strategies to sustain services access amid global health crises. Key barriers included socio-economic constraints such as unemployment and inability to afford transport, movement restrictions during lockdowns, resource shortages including staff shortages and stock-outs of essential supplies, lack of knowledge about COVID-19, inadequate communication from health facilities, and disruption of routine antenatal, postnatal, and child health services. Women reported delayed or missed care, increased anxiety, and reliance on alternative coping mechanisms. Proposed strategies included strengthening health system capacity and emergency preparedness, improving access to transport and community-based services, enhancing communication and trust through Village Health Teams and local leaders, providing financial and social support to vulnerable women, and improving inter-sectoral coordination during emergencies. The findings highlight the need to embed continuity of maternal and child health care within emergency preparedness frameworks. Community-based communication and referral mechanisms should be strengthened, while emergency transport support and other measures should ensure uninterrupted access to essential maternal and child health services during public health emergencies.