Research Theme: Access, Barriers and Systems of Care (ABSoC)

The Access, Barriers and Systems of Care (ABSoC) thematic working group has been set up to study the health system contexts within which maternity services are provided in the PRECISE countries, to explore the barriers and facilitators to accessing care, and to examine the quality of care that is provided, including whether this care is respectful of mothers’ and babies’ needs and preferences.

Mothers and newborns need access to safe, efficient and high-quality health services along the maternal and neonatal health continuum of care, spanning the pregnancy, birth and postnatal periods. This is particularly important for mothers and babies with placental disorders. On the demand side, factors that may prevent timely care-seeking may include unfamiliarity with warning signs, especially among family members, discouragement from revealing pregnancy early in gestation, gender inequalities, complex and untimely decision-making processes, fear of mistreatment by health-care providers, lack of transport and financial constraints.

However, it is not enough to reach a facility, the care available there must be timely, of good quality, and respectful. Quality care can only be provided within functional health systems, which need to have efficient and equitable financing, adequately-trained and motivated human resources, effective governance and accountability structures, functioning referral pathways, sufficient physical resources and well-functioning information systems. As outlined in the WHO Quality of Care Framework for maternal and newborn health care (see figure), the concept of quality of care itself includes both the provision and the experience of care. The provision of care includes the coverage of key practices at different contact points, that vary on a case-by-case basis depending on clinical need. In addition, care should be respectful, in that it protects women’s privacy and dignity, is equitable, ensures women and newborns are free from harm and mistreatment, and respects individual preferences, contributing to a positive experience.

Different work streams within the ABSoC group will draw on the social and implementation sciences and use a range of qualitative and quantitative research methods to explore this wide range of factors that enable or impede access to quality care for all women, including those related to the supply of and demand for services. We also plan to investigate how receiving good or poor-quality care interacts with other individual characteristics to determine more or less favourable physical and mental health outcomes for mothers and babies, with a specific focus on those with placental disorders.


Figure Title: The WHO Quality of Care Framework for maternal and newborn health care (image credit: World Health Organization)