ArticleBMC pregnancy and childbirth2026
Journey to antenatal care in pastoralist communities of Oromia Regional State, Ethiopia: Human Centered Design (HCD) approach.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMaternal mortality is unacceptably high globally, particularly in low-income countries. Even though there is positive progress, utilization of Antenatal Care (ANC) is not at the desired level in Sub-Saharan countries. Countries like Ethiopia are facing unique challenges in ensuring equitable provision of quality service, particularly among disadvantaged communities like pastoralists, where the journey of the woman is shaped by different contextual barriers. This study aims to explore the journey of pregnant women to ANC in pastoralist communities, guided by Human-Centered Design (HCD) approaches.
methodsA qualitative content analysis was conducted in pastoralist communities of Oromia from February 01, 2024, to March 30, 2025. A total of 10 FGDs and 10 observational tours were conducted to collect data involving pregnant women who utilized ANC. The HCD framework, specifically journey mapping, was applied to assess barriers and enablers across different phases of the ANC journey. Data were transcribed verbatim, coded, and analyzed thematically, adhering to Consolidated Criteria for Reporting Qualitative research (COREQ) standards. Ethical approval was obtained from the Institutional Review Board of Dilla University, and confidentiality and privacy of participants were ensured throughout the research process.
resultFour major themes identified: 1) Socio-cultural barriers, including cultural beliefs and norms discouraging early pregnancy disclosure and male-dominated decision-making; (2) Structural and systemic barriers, such as distances, poor road networks, and disrespectful provider interactions and maternal experiences of the service; (3) Economic barriers, transport costs and competing livelihood priorities; and (4) Enablers and opportunities, including the supportive roles of community health workers (CHWs), Health Extension Workers (HEWs), and some facilities providing respectful maternity care. These findings show the interrelation of social norms, infrastructure, and service provision in shaping the ANC journey.
conclusionThe journey of pregnant women accessing ANC in pastoralist communities of Oromia Regional State of Ethiopia is shaped by complex interplays of socio-cultural, structural, economic, and systemic factors. Improving ANC utilization in pastoralist settings requires locally tailored, gender-responsive, and community-driven interventions.
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