My care, my choice: a qualitative phenomenological exploration of women's rights to choose maternal healthcare providers and services in Ari Zone, Southern Ethiopia.

چکیده اصلی

OBJECTIVES: Maternal health has shifted from a narrow focus on survival to a rights-based paradigm emphasising the quality of the birthing experience. This study explored participants' lived experiences in the Ari Zone, southern Ethiopia, regarding their right to choose their preferred maternal healthcare providers. DESIGN: A qualitative descriptive phenomenological study using face-to-face, semi-structured, in-depth interviews, analysed using Colaizzi's seven-step method with OpenCode software (V.4.2). SETTING: Public maternal healthcare services in the Ari Zone, South Ethiopia Regional State, southern Ethiopia. PARTICIPANTS: 18 postpartum women (n=18), aged 20-39 years, purposively selected from women who had used maternal health services in the Ari Zone at least twice in the preceding 12 months. RESULTS: Four themes emerged. Participants described the healthcare environment as a rigid hierarchy in which top-down provider assignment and resource constraints constrained perceived choice and autonomy. The desire to select a provider was often described as a response to prior obstetric trauma or trusted community narratives about provider conduct. In the absence of formal choice, participants described informal strategies, such as timing visits to trusted shifts or emotionally withdrawing, to exert limited control over their care. They also envisioned person-centred care in which choice of provider was framed as integral to dignity and clinical safety. CONCLUSIONS: Service coverage alone did not capture important dimensions of maternal healthcare quality, including dignity, autonomy and perceived choice. Participants described how provider assignment, limited information about available providers, resource constraints and concerns about provider conduct constrained their perceived ability to exercise choice. In the absence of formal mechanisms for choosing providers, some participants described informal strategies to retain limited control over their care. These findings highlight the importance of strengthening women's participation in decisions about their maternal healthcare and creating care environments that support dignity, respect and autonomy. The findings should be interpreted within the context of this qualitative study and should not be generalised beyond the study population and setting.

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