Exploring women's perspectives of access to care during pregnancy and childbirth: a qualitative study from rural Papua New Guinea.

OBJECTIVES: to explore women's perceptions and experiences of pregnancy and childbirth in a rural community in PNG.
DESIGN: a qualitative, descriptive study comprising focus group discussions (FGDs) and in depth interviews.
SETTING: this study took place in a rural community in Eastern Highlands Province, PNG. PARTICIPANTS: 51 women participated in seven focus group discussions. In depth interviews were undertaken with 21 women, including women recruited at the antenatal clinic, women purposively selected in the community and three key informants in the community.
FINDINGS: the majority of women mentioned the benefits of receiving antenatal care at the health facility and the importance of a supervised, facility birth. Women faced numerous challenges with regards to accessing these services, including geographical, financial and language barriers. Cultural and customary beliefs surrounding childbirth and lack of decision making powers also impacted on whether women had a supervised birth. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: distance, terrain and transport as well as decision making processes and customary beliefs influenced whether a woman did or did not reach a health facility to give birth. While the wider issue of availability and location of health services and health system strengthening is addressed shorter term, community based interventions could be of benefit. These interventions should include safe motherhood and birth preparedness messages disseminated to women, men and key family and community members.