Maternal and newborn practices and care seeking in Rwanda: Formative research findings and implications

Increasing the number of women giving birth with a skilled attendant is widely recognized as critical for reducing maternal mortality. Antenatal care attendance is also important for improving maternal and newborn health outcomes and is associated with a greater likelihood of delivering with a skilled attendant. Most women in Rwanda (94%) seek antenatal care at least once but usually late in the pregnancy. Only 30% of births in Rwanda occur in facilities with a skilled attendant. The ACCESS Program is working to increase utilization and quality of antenatal, delivery, postpartum and newborn care in Rwanda. We conducted formative qualitative research in two districts to understand: barriers to seeking antenatal care, preparations for childbirth; perceived advantages and disadvantages of delivering at health facilities versus at home; care seeking for obstetric complications and postpartum care; and newborn care practices. Focus group discussions were held with recent mothers, pregnant women, husbands, and older men and women. Findings indicate there is a need to educate communities about the importance of utilizing maternal and newborn health services as well as to increase knowledge of healthy household practices for maternal and newborn care. Moreover, there is a need to address socio-cultural barriers that prevent women from accessing care. Findings are being used to design appropriate behavior change and communication interventions and messages. This is an opportune time to reach out to the community since Rwanda has embarked on a local health insurance system to decrease financial barriers to care and mobilize elected community teams to demand quality services.