The respondents mainly were aged 28–37 years catering for 84.2% with at least secondary education (44.3%). The common religion of affiliation was catholic and majority were in business sector. Majority of the respondents had high level of awareness (92.9%) although only 4.3% knew the entire package of maternity services (ANC, deliveries and PNC). Majority of the respondents (88.6%) reported interest in maternity services although 2.8% reported to opt for TBAs. Having a healthy baby, getting mama kit were reported as key motivating factors for health facility deliveries. Notably fear of being diagnosed with HIV, rude midwives and laziness were reported as barring factors for health facilities’ deliveries.
The age (28–37 years) was prevalent and it can be attributed to more active reproductive age group for women. This is in line with Uganda’s population distribution which also have majority of the population below the age of 30 years (UBOS, 2018). This is in line with another study conducted in Uganda by Sserwanga et al on contraceptives use which found that the age group was 15–32 years of age (Sserwanja et al., 2021). Many had accessed at least secondary education. This could be attributed to the fact that this was a peri urban location with many women in the informal setting but with some education achievement to help them communicate and transact business. Furthermore, this age group could have benefited from government of Uganda universal primary and secondary education which could have given majority chance to go to school. Our study findings are in line with a previous study done in Uganda where maternal child health services was affected by the education level and majority had only primary and secondary education (Nankinga and Aguta, 2019). There was a fairly almost equal distribution of religion amongst the Protestants, Pentecostals and Muslims with Catholics being the most dominant of all. This also aligns with the Uganda’s socio-demographic distribution by religion (UBOS, 2019). Our respondents mostly engaged in businesses and this could be explained by the nature of the area which neighbours Uganda’s capital city, Kampala where business is a priority. Wakiso District is also among the most enterprising and categorized as central business districts in Uganda and this could explain this trend we observed (Okure et al., 2022). In regard to the income status, 45.7% of the respondents had some form of sustained income generating activity while the remaining majority 54.3% had none or were casual labourers. This appears to have an influence on the knowledge and utilisation of maternity services since the poor would not be able to afford maternal health services and have access to information for example via radio. One of the reasons the respondents gave for none use of the services was poverty.
The greatest portion (92.9%) of the respondents was aware about the existence of maternity services. However, the majority of them understood it as only consisting of ANC and delivery (48.6%) while 20.6% only to be ANC. Very few (4.6%) understood it in the fullness of all three activities and only 1.4% was found to know PNC, most mothers were unaware of these services or their importance. These knowledge gaps could have a contribution to why there is still low uptake of the services, this is in line with a study conducted by Beraki et al that showed that there was low level of awareness on postnatal services among women (Beraki et al., 2020). Asweto et al also found out that participants identified with lack of knowledge and awareness of the community and access to information on maternal health care issues as barriers to use maternity care (Asweto et al., 2014). The low awareness of postnatal care (4.6%) differs from the findings of who found that majority (84.39%) of the mothers knew they had to receive a post-natal care services (Asweto et al., 2014).
Our study found out that majority liked to attend maternal health services (91.2%) while 89.9% felt comfortable about using them. Some of the reasons shared by the mothers for non-utilisation of the services included; high service costs, rude health workers, reluctance by the mothers to go to Health facilities, long distance from the Health facilities, unpreparedness at time of labor, ignorance and lack of support from the spouse, previous successful home delivery and availability of TBAs. This is an agreement with the findings from (Downe et al., 2016) who found that older women who had had more pregnancies successfully delivered from home saw no need for maternity services and that mothers with healthy pregnancies were reluctant to seek these services. The reasons expressed by mothers in this study are also in agreement with (Yalem and Miguel, 2010) study in which mothers gave reasons such as; economic and transport problems, lack of awareness on the advantages of maternal health care, perceived poor skills of the health service providers, the distance to the health facility and the short onset of labour.
A noteworthy 20.3% of the respondents preferred TBA services to skilled health worker provided maternity services with some of the reasons pointed out as previously explained, but also mentioned that they were more affordable and caring. This is in agreement with (Yalem and Miguel, 2010) concerning reasons for mothers’ preference for TBAs who revealed that they were more accepted by the community because of their experience and privacy of the labouring mother. (Njiku et al., 2017) revealed that 33% of mothers receiving ANC did so from untrained personnel. 90% with a favourable view and feelings towards maternity services were more likely to use the maternity services thus showing that the mothers’ attitudes towards maternity services, if positive increases utilisation of these services. 95.7% were very likely to use the services when they had knowledge of their importance. This is in agreement with (Fotso, 2006) whose study showed that if the influence of women’s perceived quality of care was strong in the expected direction for women with a high perception, they were more likely to deliver in an appropriate health facility compared to their counterparts with middle or low perception. However the findings of this study contradicted with that of (Asweto et al., 2014) where women’s perceived quality of care had no statistical significance to the utilization of antenatal care services. (Asweto et al., 2014) study also showed that most mothers had a positive perception toward post-natal care services while, mothers in a rural area possessed a negative perception, which was found to be true in the rural area of Wakiso under study, particularly in regard to the attitude towards PNC, as the women saw no need for it.
Our study is the first study to be conducted in Mende Sub county in Wakiso district on this important topic and we bring facts and key observations on the motivating and barring factors for maternity services in this area. We also visited women in their residences and got real life information on their level of awareness on maternity services and this represented real-life knowledge levels and attitude towards maternity services access. We also worked with women who are always involved in accessing maternity services and therefore we present real needs. Our study also had limitations; first we had a small sample size. This was an undergraduate student’s research project with minimal resources and this why we did a small sample size. Secondly, we only conducted quantitative study and we could have missed out a lot of explanations on their choices. Third, we also did not use a standard pretested knowledge assessment tool and this could have limited the data variables we collected. Furthermore, we did not conduct multiple logistic regression that would help us to understand the statistically significant variables to maternity services access in this area. Lastly, this study was conducted in a small area and the findings may not be representative of a wider community.