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Health services providers and users' opinions on maternal health services in Bangkok metropolis.


 Morbidity from pregnancy complications was 19.6% of inpatients in 1990 in Bangkok Metropolis. This study examines the impact of local customs on prenatal, delivery, and postpartum care; the factors affecting use of health services for prenatal care and delivery; and the nature of women's involvement in IEC for maternal health. Data was obtained from a community survey in May 1992 among 526 ever married women, 15-40 years old, from low-income communities in Bangkok Metropolis. In-depth interviews with hospital personnel were conducted at two general hospitals and three health centers, and focus groups were conducted in two communities. Findings show that Hospital A received 220 old and 80 new prenatal patients daily; Hospital B accommodated 130 old and 50 new ones. According to nurses, the major hospital problem was doctors' attitudes toward nurses. Comprehensive services were available at both hospitals. Hospital B encountered patient health problems of minor malnutrition, syphilis, and hepatitis, while Hospital A treated diarrhea and high blood pressure problems. A lack of medical personnel was reported in both settings. Low level of education was reported as related to noncompliance. Incorrect practices were identified as adherence to food taboos that led to deficiencies, consumption of whiskey with traditional medicine, which contaminated breast milk, and discarding mother's first milk. At health centers, which included family planning, doctors only saw high risk patients; complications generally were for swelling, high blood pressure, and vaginal bleeding. Not all centers had a prenatal care diagnostic manual or licensed nurses. Obstacles to delivery of health care included a lack of nurses, refusals at referral centers by low level personnel, and a poor rapport between nurses and patients, which improved with bribes. Poorly educated patients had trouble understanding their health condition. Nurses and focus groups reported that services were not convenient for patients. Migration interfered with keeping appointments. Male doctors were preferred to female doctors as nicer to patients.
