Open Access Research article

A qualitative study on barriers to utilisation of institutional delivery services in Moroto and Napak districts, Uganda: implications for programming

Calistus Wilunda1*, Gianluca Quaglio12, Giovanni Putoto1, Peter Lochoro3, Giovanni Dall’Oglio3, Fabio Manenti1, Andrea Atzori1, Rose Miligan Lochiam3, Risa Takahashi4, Aline Mukundwa5 and Koyejo Oyerinde5

Author Affiliations

1 Doctors with Africa CUAMM, via san Francesco 126, Padua, Italy

2 Department of Innovation, Research and Planning, Azienda ULSS 9, Treviso, Italy

3 Doctors with Africa CAUMM, P.O. Box 7214, Kampala, Uganda

4 College of life and Health Sciences, Chubu University, 1200 Matsumoto-cho, Kasugai, Aichi, Japan

5 Averting Maternal Death and Disability Program, Mailman School of Public Health, Columbia University, 60 Haven Avenue, B3, New York, NY 10032, USA

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BMC Pregnancy and Childbirth 2014, 14:259  doi:10.1186/1471-2393-14-259

Published: 4 August 2014



Skilled attendance at delivery is critical in prevention of maternal deaths. However, many women in low- and middle-income countries still deliver without skilled assistance. This study was carried out to identify perceived barriers to utilisation of institutional delivery in two districts in Karamoja, Uganda.


Data were collected through participatory rural appraisal (PRA) with 887 participants (459 women and 428 men) in 20 villages in Moroto and Napak districts. Data were analysed using deductive content analysis. Notes taken during PRA session were edited, triangulated and coded according to recurring issues. Additionally, participants used matrix ranking to express their perceived relative significance of the barriers identified.


The main barriers to utilisation of maternal health services were perceived to be: insecurity, poverty, socio-cultural factors, long distances to health facilities, lack of food at home and at health facilities, lack of supplies, drugs and basic infrastructure at health facilities, poor quality of care at health facilities, lack of participation in planning for health services and the ready availability of traditional birth attendants (TBAs). Factors related to economic and physical inaccessibility and lack of infrastructure, drugs and supplies at health facilities were highly ranked barriers to utilisation of institutional delivery.


A comprehensive approach to increasing the utilisation of maternal health care services in Karamoja is needed. This should tackle both demand and supply side barriers using a multi-sectorial approach since the main barriers are outside the scope of the health sector. TBAs are still active in Karamoja and their role and influence on maternal health in this region cannot be ignored. A model for collaboration between skilled health workers and TBAs in order to increase institutional deliveries is needed.

Traditional birth attendants; Maternal health; Rural health; Pastoralist health care