The Quality Gap in the Services Provided by Rural Maternity Units in Southeast of Iran

Background: Providing high-quality maternity services is crucial to increase utilization of these services and reduce maternal mortality The quality of the maternity services provided to pregnant women in rural areas of Iran is poorly understood. Objectives: This study aimed to investigate the quality gap in the maternity care services provided by Rural Delivery Facilities and Safe Delivery Posts in Sistan and Balouchestan Province, southeast of Iran, as expressed by the difference in women's perceptions and experiences of services. Patients and Methods: In this cross-sectional study a total of 438 pregnant women who gave birth in rural maternity unit were recruited between February and May 2013. The SERVQUAL questionnaire was used for data collection. The Wilcoxon Signed-Rank test was used to compare the quality gap as expressed in the mean of differences in the expectation and perception scores. The quality gap was compared between demographic groups using Kruskal-Wallis tests. Results: There was a negative gap in all dimensions of the quality of services provided. The highest quality gap was found for the reliability dimension followed by tangibles, empathy assurance and responsiveness. The participants' age, levels of education and the type of maternity unit were found to be associated with the clients' perceived quality of services. Conclusions: The quality gap in the services provided by maternity units showed that these units are not able to meet pregnant women's expectations completely. The negative quality gaps can be used as a guideline to improve the maternal health care quality and reduce maternal mortality, particularly in high-risk women such as those living in rural areas.