The role of transportation to access maternal care services for women in rural Bangladesh and Burkina Faso: A mixed methods study.
OBJECTIVE
To understand the role of transportation in accessing health care during pregnancy, delivery, and the postpartum period among women in rural Bangladesh and Burkina Faso.


METHODS
An exploratory mixed methods study was conducted in Mymensingh district in Bangladesh and Kaya district in Burkina Faso. We recruited 300 women from Bangladesh and 340 from Burkina Faso with a delivery outcome within one year of interview. Key informant interviews were conducted with 19 participants and 12 focus group discussions took place with attendees in selected community clinics.


RESULTS
Of the interviewees, 45.7% in Bangladesh and 73.2% in Burkina Faso reported having had health complications during their last pregnancy, delivery, or postpartum period. Of all women, 42.7% in Bangladesh and 67.4% in Burkina Faso sought facility care for their complications. Facility-based delivery was much higher in Burkina Faso (87.7%) than Bangladesh (38.2%). Literacy, transport availability, transportation costs, and travel time were associated with care seeking behavior.


CONCLUSIONS
Lack of reliable transportation was reported as a significant barrier to accessing care during pregnancy, delivery, and postpartum by women in Bangladesh and Burkina Faso. Effort should be made to improve access to emergency obstetric care, and transport intervention should be strengthened.
University of Montreal Hospital Research Center, Montreal, Canada; School of Public Health, University of Montreal, Montreal, Canada. Electronic address: nazmul.alam@umontreal.ca.
Nazmul
N
Alam
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Mahbub Elahi
ME
Chowdhury
Research Institute of Health Sciences, Ouagadougou, Burkina Faso; African Institute of Public Health, Ouagadougou, Burkina Faso; Kaya Health and Demographic Surveillance System, Kaya, Burkina Faso.
Seni
S
Kouanda
University of Montreal Hospital Research Center, Montreal, Canada; School of Public Health, University of Montreal, Montreal, Canada.
Mathieu
M
Seppey
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Anadil
A
Alam
African Institute of Public Health, Ouagadougou, Burkina Faso.
Justin Ragnessi
JR
Savadogo
Department of Nursing Science, University of Quebec in Outaouais, Gatineau, Canada.
Drissa
D
Sia
University of Montreal Hospital Research Center, Montreal, Canada; School of Public Health, University of Montreal, Montreal, Canada.
Pierre
P
Fournier
D001459:Bangladesh; D002050:Burkina Faso; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D012959:Socioeconomic Factors; D014187:Transportation of Patients / Q000458:organization & administration* / Q000706:statistics & numerical data*; D016387:Women's Health
Accessibility; Bangladesh; Burkina Faso; Emergency Obstetric Care; Facility Delivery; Rural areas; Transport