Submission ID 130902
| Issue/Objective | Despite increased access to maternal and newborn health care in low-resource settings, poor quality limits care-seeking and contributes to preventable deaths. Countries often rely on secondary data sources, such as Demographic and Health Surveys (DHS) and health facility assessments, to monitor quality, but these surveys are not built on women's priorities. Quality measurement, therefore, risks misidentifying gaps and misdirecting investments, failing to improve women's care. This research developed a women-centred measure of maternal care quality and assessed its implications for health system monitoring. |
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| Methodology/Approach | This presentation reports the quantitative phase of a mixed-methods study in Burkina Faso. In the qualitative component, 32 women from rural and urban communities used fuzzy cognitive mapping, a participatory method using causal maps, to identify and weight 19 categories of factors influencing maternal care quality, such as medical procedures, counselling, and hygiene standards. These categories were compared against the 2021 Burkina Faso DHS and 2020 HHFA to identify measurement gaps. A women's perspective index was then built from DHS indicators aligned with these categories, weighted by FCM-derived importance values. It was compared with a standard equal-weight DHS index. |
| Results | Alignment between women's priorities and existing tools was partial: the DHS captured 7 of 19 categories (27% of importance weight) and the HHFA 9 (41%). Seven categories were absent from both, including provider skills, waiting times, and reception at facilities. The women's perspective index included indicators absent from standard measures, such as geographical accessibility, timely ANC initiation, respectful childbirth care, and postnatal follow-up. Although mean scores were similar (0.732 vs 0.731), the indexes diverged in distributions, in individual rankings, and across the antenatal-childbirth-postnatal continuum, with the largest gap in postnatal care (0.654 vs 0.492). |
| Discussion/Conclusion | These findings confirm that existing survey tools are not built around what women identify as essential to good care. Integrating women's perspectives reveals dimensions usually overlooked in standard indexes, including respectful treatment, provider communication, and reception at facilities. Without this grounding, monitoring risks misidentifying gaps and misdirecting investments away from what matters most to women. Aligning measurement with women's priorities is essential for guiding improvements that reflect and improve the care women experience. |
| Presenters and Affiliations | Sarah Cooper École de Santé Publique de Université the Montréal Frank Bicaba Société d'Études et de Recherche en Santé Publique Alice Bila Société d'Études et de Recherche en Santé Publique Federica Fregonese Center of Research in Public Health Marie-Catherine Gagnon-Dufresne École de Santé Publique de Université the Montréal Thomas Druetz École de Santé Publique de Université the Montréal |
