BARRIERS PREVENTING ACCESS TO HEALTH CARE SERVICES FOR WOMEN IN RURAL SAMOA A thesis presented to the faculty of the Center for International Studies of Ohio University In partial fulfillment of the requirements for the degree Master of Arts Paige Lynn Miller June 2005 This thesis entitled BARRIERS PREVENTING ACCESS TO HEALTH CARE SERVICES FOR WOMEN IN RURAL SAMOA BY PAIGE LYNN MILLER has been approved for the Program of International Development Studies and the Center for International Studies by Jacqueline H. Wolf Associate Professor, Department of Social Medicine Josep Rota Director, Center for International Studies MILLER, PAIGE L. M.A. June 2005. International Development Studies Barriers Preventing Access to Health Care Services for Women in Rural Samoa (132 pp.) Director of Thesis: Jacqueline H. Wolf This study investigates and identifies the barriers preventing access to public health care services for women living in rural villages of Samoa. One hundred one women ages 20 years and older participated in personal interviews. The interviews probed the women’s use of traditional medicine, their sociocultural status, their perception of the quality of services, and the affordability and availability of health care services. The results indicate that a limited knowledge of available services, the utilization of traditional medicine, the high cost of prescription drugs, and younger age are barriers to the use of public health care services. The findings also reveal that older age, a high fertility rate, and a low education level contribute to a greater number of illnesses. Implications for improving the infrastructure of the public health care system and increasing communication between traditional healers and the public health care system are discussed. Approved: Jacqueline H. Wolf Associate Professor, Department of Social Medicine DEDICATION This thesis is dedicated to my extremely supportive, loving, and generous parents, Gerald and Lynn Miller, who have inspired me to realize all my goals. ACKNOWLEDGEMENTS There are many individuals to thank for their assistance, encouragement, and contribution to my thesis. First, I begin by thanking the women of Iva, Samoa, for their patience, generosity, and participation in my research study. Fa’afetai tele lava. Without their assistance, none of my work would have been possible. Immeasurable gratitude goes to my thesis committee chair, Dr. Jacqueline Wolf, for her inspiration, dedication, and intellectual support. She inspired me to accomplish more than I thought was possible. I would like to thank Dr. Ann Tickamyer for her guidance and friendship throughout the past year. I am thankful to her for believing in me when I doubted my own abilities. Special thanks to Dr. Gordon Brooks for his wisdom, patience, and enthusiasm about my thesis. I would also like to acknowledge and thank Albert Adusah for his assistance in helping with my statistical analysis. I would particularly like to thank Sei’a Mumu Sue for opening her home to me during my stay in Samoa. Thank you also to the Koroseta family, especially Malologa, Lelevaga, and Tali’itai, for welcoming yet another palagi daughter into their home. I also thank Se’ia and Tali’itai for their assistance with my data collection. I am most indebted to my good friend, Jill Fennimore, for her infinite wisdom about the village of Iva, her friendship, and the weekly phone calls to Samoa that helped me to maintain my sanity during my time in Samoa. Finally, my deepest gratitude goes to my parents, Gerald and Lynn Miller, who encourage, support, and love me even though I do not always make the best decisions in life, and to my best friend and sister, Penelope, who I have always looked up to as a role model and who I admire for her intelligence, honesty, and good heart. 6 TABLE OF CONTENTS Abstract..................................................................................................................................3 Dedication..............................................................................................................................4 Acknowledgements................................................................................................................5 Graphs....................................................................................................................................8 Tables.....................................................................................................................................9 Maps ....................................................................................................................................10 Abbreviations.........................................................................................................................11 Chapter 1: Introduction.........................................................................................................12 Research Questions and Hypotheses .........................................................................13 Synopsis .....................................................................................................................14 Chapter 2: Literature Review................................................................................................15 Women’s Health ........................................................................................................15 Influences on Women’s Health..................................................................................24 Access to Health Care................................................................................................27 Conclusion .................................................................................................................34 Chapter 3: Samoa: Country Background ..............................................................................36 Samoa.........................................................................................................................36 Health Care................................................................................................................43 Women in Samoa.......................................................................................................56 Conclusion .................................................................................................................59 Chapter 4: Methodology .......................................................................................................60 Research Design.........................................................................................................60 Village Selection........................................................................................................61 Tuasivi Hospital.........................................................................................................66 Data Collection..........................................................................................................67 Variables ....................................................................................................................68 Data Analysis.............................................................................................................73 7 Chapter 5: Data Analysis ......................................................................................................75 Demographics ............................................................................................................75 Question 1: What factors prevent rural women's access to health care services? ....79 Question 2: What sociocultural factors are related to illness among rural women?.98 Chapter 6: Discussion, Conclusions, Recommendations......................................................103 Discussion: Question 1 .............................................................................................103 Discussion: Question 2 .............................................................................................109 Conclusion .................................................................................................................110 Recommendations for Future Practice.......................................................................111 Limitations .................................................................................................................114 Recommendations for Future Study ..........................................................................115 References..............................................................................................................................117 Appendix A: The South Pacific Ocean Region ....................................................................125 Appendix B: Glossary of Samoan Terms .............................................................................126 Appendix C: Institutional Review Board Human Subjects Approval ..................................128 Appendix D: English Language Research Questionnaire.....................................................129 Appendix E: Samoan Language Research Questionnaire ....................................................131 8 GRAPHS Graph 2-1: Maternal Mortality Rates....................................................................................17 Graph 2-2: Fertility Rates .....................................................................................................19 Graph 2-3: Female Non-Insulin Diabetes Prevalence Rate in Samoa ..................................23 Graph 4-1: Population