Perceptions and Experiences of Inequity in The Provision and Utilization of Maternal, Newborn, and Child Health Services in Tigray, Ethiopia: A Qualitative Exploratory Study

Background: In earlier studies, we could show that rural Ethiopian maternal health services were distributed pro-rich, while child immunization coverage was equitably distributed. Hence, this study aimed at exploring rural Ethiopian mothers’ and primary healthcare workers’ perceptions of inequities and their causes in the provision and utilization of maternal, newborn, and child health services. Methods The study was conducted from August to December 2019 in two rural districts in Tigray, Ethiopia. We performed 22 in-depth interviews and three focus group discussions with mothers who had given birth the last year before the survey. We also interviewed women’s development group leaders, health extension workers at health posts, and health workers at health centers. The final sample was determined based on the concept of saturation. The interviews and focus group discussions were audiotaped, transcribed, translated, coded, and analyzed using thematic analysis. Results Mothers perceived the provision and utilization of antenatal care, facility-based delivery, and care-seeking for sick children inequitably distributed, while immunization was seen as an equitable service. The inequity in providing and utilizing maternal and child health services was linked to the economy, distance, social and cultural norms, health systems, maternal age, and education. Poor implementation of the Government’s equity-oriented policies, such as community-based health insurance, was perceived to result in health inequities. Conclusions Mothers and primary health care providers in rural Ethiopia indicated weaknesses in delivering equitable services and reasons for inequitable utilization. The narratives could inform efforts to provide universal health coverage for mothers, newborns, and children. These problems require multisectoral actions to address the identified sources of inequities.