ABSTRACT

Objectives

Bangladesh has achieved notable success in improving maternal health by increasing women’s access to good quality and low-cost maternal health care (MHC) services. However, the health system of Bangladesh has earned criticism for not ensuring equitable MHC access for all women, particularly for Indigenous women in the Chittagong Hill Tracts (CHT). Little is known about Indigenous communities’ perspectives on these inequalities in MHC service access in the CHT. Therefore, this study aimed to explore Indigenous communities’ perspectives on challenges and opportunities for improving MHC service access in the CHT.

Design

This qualitative descriptive study was conducted in two sub-districts of Khagrachhari between September 2017 and February 2018. Eight Indigenous key informants from three Indigenous communities (Chakma, Marma and Tripura) were recruited via snowballing and purposive techniques and participated in face-to-face, semi-structured interviews. Key informants comprised community leaders and health care providers. Data were analysed thematically using Nvivo12 software.

Results

Findings suggest that distance, poor availability of resources and infrastructure, lack of community engagement in the design of health interventions, Indigenous cultural beliefs, misconceptions about MHC services, and maltreatment from health care providers were the key barriers to accessing MHC services; all are interconnected. Indigenous women faced humiliation and maltreatment from MHC staff. Failure to provide a culturally-safe environment suggests a lack of cultural competency among health staff, including Indigenous staff.

Conclusion

Findings suggest that cultural competency training for all health care providers is needed to improve cultural appropriateness and accessibility of services. Refresher training and undisrupted supply of basic MHC services for front-line care providers will benefit the entire community and will likely be cost-effective for the government. Designing health programmes through extensive community consultation is essential.

中文翻译：

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孟加拉国吉大港山区土著妇女在获得孕产妇保健服务方面面临的障碍的社区观点

摘要

目标

孟加拉国通过增加妇女获得优质和低成本的孕产妇保健 (MHC) 服务的机会，在改善孕产妇健康方面取得了显著成功。然而，孟加拉国的卫生系统因未能确保所有妇女，特别是吉大港山区 (CHT) 的土著妇女平等获得 MHC 而受到批评。关于土著社区对 CHT 中 MHC 服务获取的这些不平等的看法知之甚少。因此，本研究旨在探讨土著社区对改善 CHT 中 MHC 服务获取的挑战和机遇的看法。

设计

这项定性描述性研究于 2017 年 9 月至 2018 年 2 月在 Khagrachhari 的两个分区进行。通过滚雪球和有目的的技术招募了来自三个土著社区（Chakma、Marma 和 Tripura）的八名土著关键线人，并参加了面对面的面对面交流。 ，半结构化面试。主要信息提供者包括社区领袖和医疗保健提供者。使用 Nvivo12 软件对数据进行专题分析。

结果

调查结果表明，距离、资源和基础设施不足、缺乏社区参与设计健康干预措施、土著文化信仰、对 MHC 服务的误解以及医疗保健提供者的虐待是获得 MHC 服务的主要障碍；所有这些都是相互关联的。土著妇女面临来自 MHC 工作人员的羞辱和虐待。未能提供文化安全的环境表明卫生人员（包括土著工作人员）缺乏文化能力。

结论

调查结果表明，需要对所有医疗保健提供者进行文化能力培训，以提高服务的文化适宜性和可及性。为一线护理提供者提供进修培训和不间断地提供基本的 MHC 服务将使整个社区受益，并且对政府来说可能具有成本效益。通过广泛的社区咨询设计健康计划至关重要。