Barriers to Accessing and Utilizing Facility- Based Maternity Healthcare Services: A Qualitative Investigation among Bede Women in Khulna and Bagerhat Districts

Introduction: Aligning with Sustainable Development Goal 3, the Government of

Bangladesh has emphasized equitable access to healthcare, yet some marginalized

groups of people, like the Bede community, are highly ignored in accessing the

facility-based maternal healthcare (MHC) services, such as antenatal care. While

existing research highlights barriers to utilizing MHC services faced by mainstream

women, it remains an unresearched area for not focusing on Bede women. Therefore,

this study aimed to identify barriers to Bede women accessing to and using

facility-based modern MHC services.

Methodology: An exploratory qualitative approach was used to conduct this study.

This study employed in-depth interviews (IDI) and key informant interviews.

(KII) methods to collect data. Snowball sampling was used to select participants from

Khulna and Bagerhat districts. Interview topic guides as data collection tools for IDI and KII based on the Three Delays Model was developed. Data collected from the participants were analyzed using the Framework Approach underpinned by the Three Delays Model.

Findings: Findings related to barriers were measured in terms of delays in seeking care, which are summarized into three broad themes: (i) (i) the delay in making decisions about maternity care to seek care, (ii) the delay in reaching a healthcare facility, and (iii) the delay in receiving adequate and appropriate treatment. The delay in deciding to seek care include limited awareness and understanding of maternity services, cultural beliefs and practices, nomadic lifestyle, limited decision-making power, economic hardship and discrimination and exclusion.

The delays in reaching a healthcare facility include distance and poor transportation and lack of information about maternity services. Unfriendly behavior and lower priority from providers due to their profession prevents Bede women from receiving adequate care.

Conclusion: This research has provided an in-depth understanding of the barriers that

Bede women face in utilizing facility-based MHC services. Based on the findings of

the study, some strategies, including developing a special policy for marginalized

people, especially the Bede community, building a mobile clinic, conducting an

awareness campaign, and providing health education, can be suggested to increase

facility-based MHC utilization of Bede women.

• Supervision