Under-utilisation of maternal and child health care

The central aim of this study is to identify and describe the experiences of first time mothers who are underusers of child care clinics. An attempt is made to counterbalance the tendency of researchers in this area to be judgmental of underusers who "neglect" their children, and their own health care needs, -by reporting the mothers' views of the child health services in their own terms. Underusers within a certain Health Authority area were identified using a purposely developed Index of Uptake. The achieved sample of predominantly working class mothers constituted a group of people who are particularly difficult to research. It is believed that success in locating and eliciting evidence from this group was in itself an important contribution to the research literature. In depth interviews were undertaken, and the data analysed in two ways; (1) A Subsample, made up of those having made least use of the services available to them, was analysed interpretively to provide detailed material of an idiographic kind on the lifeworld of the person and the place of medical care within it; (2) All interviews were subjected to content analysis to provide a more general picture of mothers' experiences of health care provision. The main findings include the following; (1) The particular population studied had a generally low level of visage as assessed by the index, but use of specifically medical provision was greater. A process of rational decision making is implicated. (2) Accounts of underusers' experiences highlight as a central theme the mothers' vulnerability to personal undermining by many aspects of health care provision. The thesis concludes with a discussion of the approach which health care providers adopt towards'underusers, and argues that there must be an explicit recognition of the point of view of the clients if the services are to reach this deprived segment of the community. Such recognition is rarely found in research or comment on the problem of underusage. In fact apparently irrational and blameworthy behaviour by underusers can be. rendered explicable when considered in the light of the individuals' perceptions and experiences, and this leads to a serious questioning of the utility and appropriateness of the negative judgements made of them.