International Journal of Environmental and Biological Sciences Articles Publishing terms and rules Vol. 1 No. 3 (2026): Third Issue - July 2026 2026-07-31

Barriers and Facilitators to Utilizing BEmONC Services: A Cross-Sectional Study of Rural Health Centers in Basrah Facilitators and Utilizing BEmONC Services

  • Maisaa Y. Mohamed
  • Jinan A. Najm A. Najm
  • Huda H. Muhaibes

01Abstract

Background: Maternal mortality is a global health priority, yet in rural Basrah, the utilization of Basic Emergency Obstetric and Newborn Care (BEmONC) remains low despite service availability. Objectives: This study aimed to Therefore, this study aimed to evaluate the socio-demographic characteristics of rural women, determine childbirth service utilization patterns, identify barriers preventing the use of PHC delivery rooms, and explore factors that facilitate their utilization. Methodology: A descriptive, cross-sectional study was conducted with 331 women across six rural sectors in Basrah (Al-Hartha, Shatt al-Arab, Al-Zubair, Al-Dair, Al-Medainah, and Abi Al-Khasib). Results: Out of the parous women surveyed (n=299), only 16.7% delivered in PHC centers, while 73.2% preferred governmental hospitals. This utilization gap is primarily driven by a trust gap regarding the centers' ability to handle complications and 24/7 staffing. From the total sample (N=331), prominent socio-demographic barriers were identified, including high maternal unemployment (88.8%) and limited formal education (61% illiterate or primary level), which heavily influence traditional family-based decision-making. Conclusion: Physical proximity alone does not guarantee service use. Recommendations include enhancing clinical trust through 24/7 qualified staffing, establishing robust referral systems, and targeting younger women with awareness campaigns.

Keywords BEmONC Maternal Health Primary Health Care Basrah Obstetric Care Rural Health Health Service Utilization Iraq

02Authors

Maisaa Y. Mohamed
1Community Medicine Consultant, Public Health Department, Basrah Health Directorate, Ministry of Health, Basrah, Iraq
Jinan A. Najm A. Najm
Family Medicine Consultant, Public Health Department, Basrah Health Directorate, Ministry of Health, Basrah, Iraq
Huda H. Muhaibes
Community Medicine Specialist, Basrah Health Directorate, Ministry of Health, Basrah, Iraq

03Article Details

Section
Articles Publishing terms and rules
Pages
75-100
Published
2026-07-31

How to Cite

Barriers and Facilitators to Utilizing BEmONC Services: A Cross-Sectional Study of Rural Health Centers in Basrah: Facilitators and Utilizing BEmONC Services. (2026). International Journal of Environmental and Biological Sciences, 1(3), 75-100. https://doi.org/10.63939/qnabkq21

04References

  1. 1. World Health Organization. Monitoring emergency obstetric care: a handbook. Geneva: World Health Organization; 2009.
  2. 2. Ministry of Health Iraq. Annual Statistical Report 2024. Baghdad: Ministry of Health; 2024.
  3. 3. Tappis H, Lak R, Alhilfi R, Zangana AH, Wadi F, Hipgrave D, Ibrahim S. Quality of maternal and newborn health care at private hospitals in Iraq: a cross-sectional study. BMC Pregnancy Childbirth. 2023;23(1):1-12.
  4. 4. World Health Organization, UNICEF. Joint Institutional Assessment of Emergency Obstetric and Newborn Care (EmONC) Readiness in Iraq. Baghdad: WHO Representative Office in Iraq; 2021.
  5. 5. Fares KK, Shabila NP. Perspectives of Kurdish Postnatal Women on Respectful Maternity Care: A Qualitative Study. Health Sci Rep. 2024;7(4):e1985.
  6. 6. Salman HM, Al-Tameemi MA, Al-Sabah AA. Evaluation of primary health care services quality and utilization in Iraq: a cross-sectional study. BMC Health Serv Res. 2023;23(1):412.
  7. 7. World Health Organization. Defining competent maternal and newborn health professionals: background document to the 2018 joint statement by WHO, UNFPA, UNICEF, ICM, ICN, FIGO and IPA. Geneva: World Health Organization; 2018.
  8. 8. Al-Khafaji A, Webster J, Marzouk M, Al-Ali A, McKee M. Structural and financial challenges facing the Iraqi health system: a qualitative study of policy-makers' perspectives. Lancet Reg Health Eur. 2024;38:100842.
  9. 9. World Health Organization. Standards for improving quality of maternal and newborn care in health facilities. Geneva: WHO; 2016.
  10. 10. 10.Ministry of Health Iraq. National strategy for reducing maternal mortality 2024-2030. Baghdad: MOH Press; 2024.
  11. 11. Hussein A, et al. Trust and perception of primary healthcare services in conflict-affected regions: A study from Iraq. Int J Health Plan Manage. 2022;37(4):2100-2115.
  12. 12. Kruk ME, Leslie HH, Verguet S, Mbaruku GM, Adanu RM, Balsara ZP. Quality of basic and comprehensive emergency obstetric care services: emergency obstetric care is not just availability. BMC Pregnancy Childbirth. 2016;16(1):1-9.
  13. 13. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196-e1252.
  14. 14. Koblinsky M, Chowdhury ME, Moran A, Ronsmans C. Maternal morbidity, mortality and system of care. Bull World Health Organ. 2012;90(10):714-714A.
  15. 15. Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284-1299.
  16. 16. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Health Policy Plan. 1994;9(2):109-144.
  17. 17. Ijadunola KT, et al. Unavailability of essential obstetric care services in south-west Nigeria. J Health Popul Nutr. 2007;25(1):94-100.
  18. 18. Banke-Thomas A, et al. Distance and cost as barriers in Nigeria. Afr J Reprod Health. 2017; 21:31-44.
  19. 19. Carlough M, McCall M. Skilled birth attendance in Nepal. Int J Gynaecol Obstet. 2005;89: S9-17.
  20. 20. Al-Ghanim SA. Barriers to PHC utilization in Saudi Arabia. J Family Community Med. 2012; 19:76-81.
  21. 21. Hatamleh R, et al. Quality of childbirth care in Jordan. Midwifery. 2013; 29:640-6.
  22. 22. El-Zanaty F, Way A. Egypt Demographic and Health Survey 2014. Cairo: MoHP; 2015.
  23. 23. Ene JC, Ajibo HT. Optimizing the utilization of maternal and reproductive healthcare services among women in low-resourced Nigerian settings. BMC Public Health 2023; 23: 2070–2070.
  24. 24. Nirmala. M. COMMUNITY PERCEPTIONS AND USE OF REPRODUCTIVE HEALTH SERVICES IN RURAL INDIA. JTH Journal of Technology and Health 2025; 2: 196–204.
  25. 25. Almiah ZAK, Alattar SAAA, Alyaseen BAAR. Prevalence and risk factors of obstetric complications in urban and rural settings. International Journal of Clinical Obstetrics and Gynaecology 2025; 9: 5–8.
  26. 26. Rachmawati T, Supriyanto S, Faisal DR, et al. Understanding the drivers associated with maternal delivery choices: comparative study between urban and rural women in Indonesia. Korean Journal of Family Medicine 2025; 47: 119–126.
  27. 27. Worgu GO, Abueh PN, Orogun SO, et al. Where are the Mothers Going to Deliver? A Study of Birthplace Preference in a Rural Community in South-South Nigeria. Nigerian Journal of Medicine 2025; 34: 53–59.
  28. 28. Rehman MAU, Malik A. An Analysis of the Access and Utilization of Reproductive Health Care Services among Women in District Kohat. Social science review archives 2025; 3: 651–666.
  29. 29. Veerappan VR, Kundu SS, Arora H, et al. 260 Barriers to the Delivery of Obstetric Care Within Primary Health Centres (PHC) in India- a Scoping Review. British journal of surgery; 111. Epub ahead of print 1 July 2024. DOI: 10.1093/bjs/znae163.126.
  30. 30. Raddam HK, Azeez MF. Ensuring the Quality of Maternity and Child Care Services in Primary Health Care Centers. Journal of Nursing Research Patient Safety and Practise 2024; 1–7.
  31. 31. Curry DE, Islam MdA, Sarker BK, et al. A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh. Human Resources for Health 2023; 21: 7–7.
  32. 32. Khalid A, Haider KA, Ahmer H, et al. Why do women still give birth at home; perceptions of Pakistani women and decision-makers from marginalized communities. PLOS Global Public Health; 3. Epub ahead of print 13 October 2023. DOI: 10.1371/journal.pgph.0002217.
  33. 33. Korsah KA. Beyond Proximity: A Qualitative Analysis of Socio-Cultural Barriers to Maternal Health Service Uptake in Rural Communities of Ghana’s Greater Accra and Central Regions. IARJSET; 12. Epub ahead of print 3 November 2025. DOI: 10.17148/iarjset.2025.121103.
  34. 34. Ajegbile ML. Closing the gap in maternal health access and quality through targeted investments in low-resource settings. Journal of Global Health Reports; 7. Epub ahead of print 13 October 2023. DOI: 10.29392/001c.88917.
  35. 35. Johnson T, Pierce H. Trends in health facility deliveries by time, region, and sociodemographic characteristics in low- and middle- income countries. BMC Pregnancy and Childbirth 2025; 25: 896–896.
  36. 36. Ayawine A, Asaarik MJA, Atinga RA. Stakeholder opinions on perceived sub-standard emergency obstetric and newborn care in Ghana. BMC Health Services Research 2024; 24: 461–461.
  37. 37. Bobo FT, Asante A, Woldie M, et al. Evaluating equity across the continuum of care for maternal health services: analysis of national health surveys from 25 sub-Saharan African countries. International Journal for Equity in Health 2023; 22: 239–239.
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