Perceptions of prenatal and obstetric care in Sub-Saharan Africa

BackgroundThe maternal mortality ratio in Sub-Saharan Africa remains high, despite progress in reducing maternal mortality in other parts of the world.ObjectiveTo explore the perceptions of women and communities to identify barriers to the uptake of obstetric services.Search strategyA systematic review of qualitative studies exploring perceptions of pregnancy and obstetric services, with thematic synthesis of the included studies.Selection criteriaQualitative studies reporting findings from focus group discussions and in-depth interviews between 1996 and 2009 were included.Data collection and analysisThematic synthesis involved collating and reviewing quotations taken directly from included studies. Themes were generated and clustered for analysis.Main resultsTwenty-seven studies were included and 6 major themes identified: perceptions of healthcare workers; perceptions of the hospital environment; cultural perceptions of women; cultural perceptions of pregnancy; perceptions of traditional birth attendants and traditional healers; and role of the community in pregnancy and birth.ConclusionCommunity attitudes regarding cultural beliefs and interactions with healthcare providers were identified as barriers to the utilization of healthcare services during pregnancy in Sub-Saharan Africa. These prevent engagement with prenatal care and timely use of medical services. Addressing the barriers will be seminal to the success of any healthcare intervention.