title: A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda.
abstract: BACKGROUND
  Armed conflict has been described as an important contributor to the social determinants of health and a driver of health inequity, including maternal health. These conflicts may severely reduce access to maternal health services and, as a consequence, lead to poor maternal health outcomes for a period extending beyond the conflict itself. As such, understanding how maternal health-seeking behaviour and utilisation of maternal health services can be improved in post-conflict societies is of crucial importance. This study aims to explore the determinants (barriers and facilitators) of women's uptake of maternal, sexual and reproductive health services (MSRHS) in two post-conflict settings in sub-Saharan Africa; Burundi and Northern Uganda, and how uptake is affected by exposure to armed conflict.
  
  
  METHODS
  This is a qualitative study that utilised in-depth interviews and focus group discussions (FGDs) for data collection. One hundred and fifteen participants took part in the interviews and FGDs across the two study settings. Participants were women of reproductive age, local health providers and staff of non-governmental organizations. Issues explored included the factors affecting women's utilisation of a range of MSRHS vis-à-vis conflict exposure. The framework method, making use of both inductive and deductive approaches, was used for analyzing the data.
  
  
  RESULTS
  A complex and inter-related set of factors affect women's utilisation of MSRHS in post-conflict settings. Exposure to armed conflict affects women's utilisation of these services mainly through impeding women's health seeking behaviour and community perception of health services. The factors identified cut across the individual, socio-cultural, and political and health system spheres, and the main determinants include women's fear of developing pregnancy-related complications, status of women empowerment and support at the household and community levels, removal of user-fees, proximity to the health facility, and attitude of health providers.
  
  
  CONCLUSIONS
  Improving women's uptake of MSRHS in post-conflict settings requires health system strengthening initiatives that address the barriers across the individual, socio-cultural, and political and health system spheres. While addressing financial barriers to access is crucial, attention should be paid to non-financial barriers as well. The goal should be to develop an equitable and sustainable health system.
authors: Peace Research Institute Oslo, PO Box 9229, Grønland, Oslo, Norway. prichi@prio.org.|Institute of Health and Society, University of Oslo, PO Box 1130, Blindern, Oslo, Norway. prichi@prio.org.
authors: Primus Che
authors: PC
authors: Chi
authors: International Organization for Migration, Plot 6A, Naguru Crescent, Kampala, Uganda. pbulage@iom.int.
authors: Patience
authors: P
authors: Bulage
authors: Peace Research Institute Oslo, PO Box 9229, Grønland, Oslo, Norway. henriku@prio.org.
authors: Henrik
authors: H
authors: Urdal
authors: Institute of Health and Society, University of Oslo, PO Box 1130, Blindern, Oslo, Norway. johanne.sundby@medisin.uio.no.
authors: Johanne
authors: J
authors: Sundby
mesh_terms: D000328:Adult; D000068337:Armed Conflicts / Q000523:psychology; D002063:Burundi; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D000068097:Maternal Health / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D011247:Pregnancy; D036301:Qualitative Research; D034121:Reproductive Health Services / Q000706:statistics & numerical data; D014454:Uganda
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