Utilization of maternal health care services in the department of Matagalpa, Nicaragua.

OBJECTIVES To better understand the individual and community factors and perceptions that influence women's health care-seeking behaviors during pregnancy in order to increase women's utilization of maternal health services. METHODS This study investigates the logistical and sociocultural barriers influencing women's utilization of maternal health services through 37 semi-structured in-depth interviews with women from the department of Matagalpa, Nicaragua. RESULTS Results reveal that delays in seeking health care during pregnancy are influenced not only by poor access to care and economic barriers but also by individual and community knowledge and acceptance of maternal health services. Partner support, previous maternal health care experiences, and the degree of communication with other women and health workers affect women's decisions to seek care. CONCLUSIONS Evidence suggests that in order to improve maternal health outcomes in this region, interventions must be targeted at a hierarchy of levels: individual, household, and community.