# ‘God is the one who give child’: An abductive analysis of barriers to postnatal care using the Health Equity Implementation Framework

## TL;DR

This study explores how cultural preferences and safety influence postnatal care access in Ethiopia, suggesting ways to improve care through cultural consideration.

## Contribution

The paper proposes integrating cultural safety into the Health Equity Implementation Framework as a process outcome.

## Key findings

- Health providers often overlook women's cultural safety as a primary need.
- Women's refusal of postnatal care is often a way to assert cultural safety.
- Adding cultural safety to HEIF can improve postnatal care access in LMICs.

## Abstract

Postnatal care is recommended as a means of preventing maternal mortality during the postpartum period, but many women in low- and middle-income countries (LMICs) do not access care during this period. We set out to examine sociocultural preferences that have been portrayed as barriers to care.

We performed an abductive analysis of 63 semi-structured interviews with women who had recently given birth in three regions of Ethiopia using the Health Equity Implementation Framework (HEIF) and an inductive-deductive codebook to understand why women in Ethiopia do not use recommended postnatal care.

We found that, in many cases, health providers do not consider women’s cultural safety a primary need, but rather as a barrier to care. However, women’s perceived refusal to participate in postnatal visits was, for many, an expression of agency and asserting their needs for cultural safety.

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We propose adding cultural safety to HEIF as a process outcome, so that implementers consider cultural needs in a dynamic manner that does not ask patients to choose between meeting their cultural needs and receiving necessary health care during the postnatal period.