Barriers to accessing adequate maternal care in Latvia: A mixed-method study among women, providers and decision-makers

Elina Miteniece, Milena Pavlova, Bernd Rechel, Dace Rezeberga, Liubovė Murauskienė, Wim Groot

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Introduction: Latvia has a high maternal mortality ratio compared to other European countries, as well as major inequities in accessing adequate maternal care. Adequacy refers to the extent to which services are safe, effective, timely, efficient, equitable and people-centred. This study aims to explore stakeholder views on access to adequate maternal care in Latvia and the extent to which there was consensus. Methods: This mixed-method study is based on an online survey among women who recently gave birth, as well as interviews with healthcare providers and decision-makers. The data were analysed using the method of directed qualitative content analysis. The extent of stakeholder consensus was determined by studying five access-related aspects of maternal care: availability, adequacy, affordability, approachability and acceptability. Findings: Our study identified barriers to accessing adequate maternal care related to availability (i.e. shortage of human resources, geographical distance) and appropriateness (i.e. inequalities in provider knowledge, care provision and use of clinical guidelines). Other challenges were related to providers’ approaches towards women (i.e. communication) and, to a lesser extent, maternal care acceptance by women (i.e. health literacy). Conclusions: The barriers identified in our study highlight areas that should be addressed in future reforms of maternal care. These barriers also indicate the need for micro-level indicators that can facilitate a comprehensive evaluation of maternal care in Latvia and elsewhere.

Original languageEnglish
Pages (from-to)87-95
Number of pages9
JournalHealth Policy
Issue number1
Publication statusPublished - Jan 2019


  • Access
  • Central and Eastern Europe
  • Latvia
  • Maternal care
  • Pregnancy
  • Quality

Field of Science*

  • 3.2 Clinical medicine
  • 3.3 Health sciences

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


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