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Assessment of Barriers to Reproductive Health Service Utilization Among Bench Maji Zone Pastoralist Communities

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Assessment of Barriers to Reproductive Health Service Utilization Among Bench Maji Zone Pastoralist Communities Assessment of Barriers to Reproductive Health… Andualem H. et al. 523 ORIGINAL ARTICLE Assessment of Barriers to Reproductive Health Service Utilization among Bench Maji Zone Pastoralist Communities 1* 2 Andualem Henok , Emwodish Takele ABSTRACT OPEN ACCESS BACKGROUND: The reproductive health (RH) needs and challenges in Citation: Andualem Henok, pastoralist area are different from elsewhere. People in this area live in Emwodish Takele. Assessment of very traditional settings and adhere strongly to traditional cultural values Barriers to Reproductive Health Service Utilization among Bench and beliefs. Some of these beliefs are known to lead to poor sexual and Maji Zone Pastoralist Communities. RH outcomes. Thus, the objective of the study was to identify barriers of Ethiop J Health Sci.2017;27(5):523. doi:http://dx.doi.org/10.4314/ejhs.v RH service utilization among pastoralist communities of Bench Maji 27i5.11 zone. Received: February 28, 2017 METHODS: This study was conducted in pastoralist communities of 5 Accepted: April 2, 2017 Published: September 1, 2017 woredas in Bench Maji zone. Qualitative study was conducted through Copyright: © 2017 Andualem FGD, IDI and KII. For this study 15 FGDs, 5 IDI and 5 KII were Henok. This is an open access conducted. Recorded data was first transcribed in to local languages and article distributed under the terms of the Creative Commons Attribution translated to English by experts. The data was coded and themes were License, which permits unrestricted identified. Finally the result was presented narratively. use, distribution, and reproduction in any medium, provided the RESULTS: The major challenges of RH service utilization identified in original author and source are this study were preference of female professionals, preference of home credited. delivery, cultural influences, lack of knowledge, decision maker related Funding: Family Guidance Association of Ethiopia barriers, and health facility related barriers. Husband disapproval was Competing Interests: The authors significant challenge for utilization of services. Family disapproval for declare that this manuscript was adolescent RH service utilization and judgmental approach of health approved by all authors in its form and that no competing interest exists. professionals for contraceptive utilization were also common barriers. Affiliation and Correspondence: CONCLUSIONS: Preference of female professionals, preference of home 1Department of Public Health, Mizan-Tepi University, Mizan, delivery, cultural influences, lack of knowledge, decision maker barrier, Ethiopia and health facility related barriers were identified barriers. Therefore, 2Department of Sociology, awareness creation to the community, and capacity building to health Mizan-Tepi University, Mizan, Ethiopia professionals are recommended. *Email:[email protected] KEYWORDS: Reproductive health, Barriers, Pastoral, Ethiopia INTRODUCTION The reproductive health (RH) needs and challenges in pastoralist area are different from those elsewhere. People in these areas have limited access to information and services. This is not simply due to the mobility that pastoralist communities have. But other factors also play a role. They live in very traditional settings and adhere strongly to traditional cultural values DOI: http://dx.doi.org/10.4314/ejhs.v27i5.11 524 Assessment of Barriers to Reproductive Health… Andualem H. et al. and beliefs. Some of these beliefs are known to services in the pastoralist areas of the zone. lead to poor sexual and reproductive health Therefore, this study is intended to show the (SRH) outcomes (1). barriers of RH service utilization in Bench Maji In Maasai (Kenya), traditional values are Zone pastoralist areas while understanding this that a woman’s social worth is largely determined will have an important value for informing by how many children she gives birth to (2).In policy-makers in designing appropriate strategies pastoralist areas of Tanzania, there is low for providing RH services for pastoralist women attractiveness of remote posts and difficulty in and youths. recruiting health workers to these areas. Long distances to facilities and poor infrastructure are METHODS challenges of access (1). Study area and period: This study was The results of studies conducted on conducted in pastoralist communities of five Ethiopian, Kenyan and Tanzanian pastoral woredas (districts) in Bench Maji Zone. These communities are generally characterized by poor woredas are Surma, Bero, Maji, MenitGoldia and RH outcomes. Low access to RH services, low MenitShasha. Bench Maji Zone has 838,235 education levels and the high prevalence of people in 247 kebeles (smallest administrative potentially harmful traditional practices are units) and 10 woredas. Among these 10 woredas, important contributing factors (3). the five woredas mentioned above have In addition, the capacity of the formal pastoralist kebeles. The study was conducted health care systems in pastoralist settings is from October to November, 2016. generally very weak. Service providers show limitations in their ability to provide services and Study design: Qualitative study was conducted generally lack the knowledge and skills required through FGD (Focused group discussion), IDI to address the traditional pastorals’ SRH needs (In-depth interview) and KII (Key informant effectively(4). interview). Maternal and neonatal morbidity and Study population: For FGDs of youths mortality rates in Ethiopia are among the highest population of 18-24 years were involved. For in the world and are attributable to a range of FGD of mothers women who ever gave birth socioeconomic, political and demographic were included. For FGD of male men who are factors. The dangers associated with giving birth married and have children were included. For IDI at home are ever-present in communities religious leader/clan leader and for KII health throughout the country (5).A high proportion of professionals were included. women in Afar experience high-risk pregnancies Sample size and sampling technique: For this and deliveries. Utilization rates of RH services study, 15 FGDs, 5 IDIs and 5 KIIs were are low, few births (6%) are attended by skilled conducted. Five FGDs were on youths, 5 were on personnel and services are not equipped to fathers, and 5 were on mothers. The IDIs were provide emergency care. Moreover, uptake of conducted among religious/clan leaders, and KIIs contraception is among the lowest in the country were conducted among health professionals. The (6.6%) (1). sample size was decided based on saturation of Understanding the context of such beliefs data. The study participants who could actively and practices is central to developing strategies to involve in the discussion were selected for group ensure positive outcomes for both the mother and discussion. For FGDs of youths, people who were the infant. 18 to 24 years old were selected through Bench Maji Zone is one of the zones in Southern purposive sampling technique by local Family Nations Nationalities and Peoples Region Guidance Association of Ethiopia (FGAE) focal (SNNPR). The zone contains 10 woredas and five persons. Among the five FGDs conducted on of the woredas have pastoralist kebeles. There is youths, three were among females and the no previously conducted study on barriers of RH remaining two were among males. The DOI: http://dx.doi.org/10.4314/ejhs.v27i5.11 Assessment of Barriers to Reproductive Health… Andualem H. et al. 525 discussions were conducted separately. For FGDs study participants. Informed consent of the conducted among fathers males who were respondents was obtained. married and have children, were selected purposively by FGAE focal persons. For FGDs RESULTS conducted among mothers women who ever gave Sociodemographic characteristics of study birth were selected purposively by FGAE focal participants: Among the study participants, persons. For IDIs religious or clan leaders who nearly equal numbers were taken from each of know the local culture and were acceptable by the five woredas. Half of the participants were community were selected purposively. For KIIs, females. Regarding age of the participants, nearly senior health professionals who had worked in one-third were in the age group of more than 35 the study area were selected purposively. years. More than half of the study participants Data collection technique: The data collection (52.4%) had no formal education (Table 1). was conducted by using FGD, IDI and KII guidelines which were developed by the principal Table 1: Sociodemographic characteristics of investigators. The guides were first developed in study participants English and later translated into respective languages (Menit language for MenitGoldia and Characteristics Frequency % MenitShasha woredas, Dizzi language for Bero Woreda and Majiworedas, Suri language for Surma Surma 26 20.9 woreda) by language experts. Data collection was Maji 24 19.4 done by health professionals who were fluent in Bero 26 21.0 the respective local languages. The FGDs were MenitGoldia 25 20.2 facilitated by BSc (Bachelor of Science) nurses MenitShasha 23 18.5 who fluently spoke the local languages and Total 124 100 trained on FGD facilitation. Training was Sex provided on data collection for two days. Male 67 50 Separate and silent rooms were selected for Female 67 50 discussions and interviews. All interviews were Total 124 100 tape-recorded and notes were taken. Age (years) Data analysis procedure: Recorded data were <25 42 33.9
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