Needs, Experiences, Barriers and Facilitators to Primary and Maternal Healthcare Accessibility and Utilisation among Women in Rural Bangladesh: A Mixed Methods Study

Introduction: The Bangladeshi government has sought to improve primary healthcare (PHC) and its maternal healthcare (MHC) services through the priorities of the nation’s Sustainable Development Goals. Despite reducing maternal mortality rates, challenges still remain for rural Bangladeshi women in both accessing and utilising those healthcare services. Therefore, further exploration of the access and utilisation of PHC and MHC services by rural Bangladeshi women is a necessary first step to help improve their overall health and well-being.
Methods and findings: An exploratory sequential mixed methods design comprising two studies was undertaken. Study 1 was a qualitative study using focus groups and interviews with women, their husbands and healthcare providers. Themes were developed using Framework Analysis, underpinned by the Theoretical Domains Framework. Five themes summarised the key barriers: i) a limited understanding in healthcare services; ii) intrapersonal barriers such as fear; iii) sociocultural barriers such as lack of family support; iv) organisational barriers including inadequate medicines; and v) environmental constraints including natural disasters. The key facilitators were: a) health self-management techniques including service utilising experience; b) sociocultural facilitators such as support from spouses; and c) organisational support including free services.
Study 2, was a quantitative and qualitative study, where Nominal Group Technique workshops were employed with women, local policy makers and healthcare professionals, to prioritise solutions to the healthcare access barriers. The top solutions were about raising awareness of healthcare services and preventive healthcare, reaching a 51% level of agreement between the participants.
Conclusions: This study has provided an in-depth understanding of the barriers and facilitators experienced by rural Bangladeshi women in accessing and utilising PHC and MHC services. Components of the access and utilisation intervention were developed. This study’s findings have key policy implications for: a) addressing the health-related knowledge gap evident in rural Bangladeshi women, and b) the delivery of quality healthcare services.