Article Text

PDF
Getting women to hospital is not enough: a qualitative study of access to emergency obstetric care in Bangladesh
  1. E Pitchforth1,
  2. E van Teijlingen2,
  3. W Graham3,
  4. M Dixon-Woods1,
  5. M Chowdhury4
  1. 1Social Science Group, Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK
  2. 2Department of Public Health and Dugald Baird Centre for Research on Women’s Health, University of Aberdeen, Medical School, Aberdeen AB25 2ZD, UK
  3. 3IMMPACT, University of Aberdeen, Aberdeen AB25 2ZY, UK
  4. 4James P Grant School for Public Health, BRAC University, 66 Mohakhali, Dhaka 1212, Bangladesh
  1. Correspondence to:
 DrE Pitchforth
 Social Science Group, Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK; elp17{at}le.ac.uk

Abstract

Objective: To explore what happened to poor women in Bangladesh once they reached a hospital providing comprehensive emergency obstetric care (EmOC) and to identify support mechanisms.

Design: Mixed methods qualitative study.

Setting: Large government medical college hospital in Bangladesh.

Sample: Providers and users of EmOC.

Methods: Ethnographic observation in obstetrics unit including interviews with staff and women using the unit and their carers.

Results: Women had to mobilise significant financial and social resources to fund out of pocket expenses. Poorer women faced greater challenges in receiving treatment as relatives were less able to raise the necessary cash. The official financial support mechanism was bureaucratic and largely unsuitable in emergency situations. Doctors operated a less formal “poor fund” system to help the poorest women. There was no formal assessment of poverty; rather, doctors made “adjudications” of women’s need for support based on severity of condition and presence of friends and relatives. Limited resources led to a “wait and see” policy that meant women’s condition could deteriorate before help was provided.

Conclusions: Greater consideration must be given to what happens at health facilities to ensure that (1) using EmOC does not further impoverish families; and (2) the ability to pay does not influence treatment. Developing alternative finance mechanisms to reduce the burden of out of pocket expenses is crucial but challenging. Increased investment in EmOC must be accompanied by an increased focus on equity.

  • EmOC, emergency obstetric care
  • SWO, Social Welfare Organization
  • emergency obstetric care
  • access
  • qualitative methods
  • Bangladesh
  • EmOC, emergency obstetric care
  • SWO, Social Welfare Organization
  • emergency obstetric care
  • access
  • qualitative methods
  • Bangladesh

Statistics from Altmetric.com

Footnotes

  • Funding: Emma Pitchforth was funded by the University of Aberdeen, Carnegie Trust Scotland and the Phil Strong Memorial Prize (British Sociological Association’s Medical Sociology Group).

  • Conflicts of interest: none.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Quality Lines
    David P Stevens