Vulnerability in illness : household healthcare-seeking processes during maternal and child illness in rural Lao PDR

Abstract

Background: Despite considerable progress, maternal and child mortality persists and continues to affect many low-income countries, to the extent that the Millennium Development Goals (MDG) 4 and 5 will not be reached. This calls for a broader range of information that will enhance the understanding of the different dimensions of healthcare-seeking. This must be grounded in people’s social reality, not least among remote, rural populations.

Aim: The overall aim is to contribute new knowledge on household healthcare-seeking processes, and coping strategies during maternal and child illness, in the context of Lao PDR.

Methods: The data originates from two main studies. The first one took place in Xekong and Savannakhet provinces (Articles I-III) and explored how healthcare- seeking takes place and the rationales behind those processes during child illness, pregnancy and childbirth. In each of six rural communities, focus group discussions (FGDs) and in-depth semi-structured interviews were conducted with mothers and fathers to children under five; pregnant women and grandmothers; and a variety of healthcare providers. The second study took place in the provinces of Phongsaly, Vientiane and Attapeu and aimed to describe households’ experiences of shocks when facing drought, pest infestation, divorce and disease (article IV). In 11 communities, FGDs and in-depth semi-structured interviews were conducted. Interviews with households that had experienced serious maternal and child illness were analyzed for sources of vulnerability, coping strategies and shock consequences. Transcripts of the data collected were analyzed and guided by interpretive description.

Results: Several households had experienced serious health shocks. High costs (medical and non-medical), limited possibilities to rapidly mobilize cash and long distances to health facilities were barriers for seeking healthcare (IV). Only in communities with poor access to healthcare facilities had the death of children - after only consulting traditional healers – occurred (I). In healthcare-seeking processes, delays were observed at household level due to either difficulty in assessing the severity of illness symptoms or to disagreements between spouses and between parents and grandparents (I). During important situations such as the first trimester of pregnancy and childbirth, grandmothers were considered important sources of advice for young women. Their status was in part based on the impressive changes they had themselves experienced in childbirth practices (III). The risks of dying outside the community had influenced women to seek local healthcare providers (I), as had their lack of knowledge about the expectations and social norms of health facilities (II).

Conclusions: Sources of vulnerability are many, including the inability to mobilize cash to pay for healthcare despite severe illness; and the spending of savings and selling assets, which nevertheless would not always result in the recovery of the family member. Understanding if, how and when healthcare-seeking is initiated, stopped or continued is important in reaching out to groups in areas that are poorly served or not yet using healthcare services. This is one of many challenges in achieving MDG 4 and 5.