SOCIAL AND PSYCHOLOGICAL COSTS OF PREVENTIVE CHILD HEALTH-SERVICES INHAITI

Much of the research on determinants of health service utilization has focused on economic and cognitive variables which influence preventat ive health behavior. Our ethnographic study of maternal perceptions of the barriers and incentives to immunization use in Haiti underscores the importance of 'hidden' social and psychological costs of utilizati on, such as embarrassment, fear, child care difficulties, and competin g demands on maternal time. Findings from focus group interviews with mothers, individual interviews with health care providers, and observa tion at health posts identified five categories of maternal factors (c ompeting priorities, low motivation, socioeconomic constraints, fears about health or social consequences, knowledge and folk beliefs) and f ive categories of system factors (accessibility, acceptability, availa bility, accommodation, affordability) which can deter immunization com pletion. The discussion focuses on how these factors influence materna l decision-making regarding use of preventive child health services. M ore attention is needed on the psychosocial costs of hearth behavior i n developing country settings.