Why Rural Women Use-or Avoid-Maternal Health Services : Insights from a Qualitative Study in Bolivia

Bolivia has achieved significant improvements in its reproductive health indicators in recent years. Yet the country's maternal mortality ratio, at 206 per 100,000 women in 2015, was the second highest in the Latin American and Caribbean region after Haiti. Bolivia's indigenous women are particularly vulnerable to death from complications related to pregnancy, childbirth, and the post-partum period. In the past, there have been no studies that sought the views of health providers and users to understand and address this problem in rural indigenous communities. This study fills that gap by tapping this experiential knowledge in these communities in Bolivia and gain insights into supply- and demand-side barriers that keep women away from institutional maternal health services. Increasing their use of quality maternal care is vital to long-term goals to lower the country's maternal mortality ratio. Both supply- and demand-side influences restrain the uptake of maternal health services by rural indigenous women. Strengthening the quality of maternal health services, including provider-user interactions, is a first and foremost priority that can be combined with targeted behavior change interventions to reduce community, household, and individual constraints on women seeking maternal health services