Beyond coverage: maternal preparedness for infant care in Bulgaria, mixed-methods evidence

Background

High utilisation of maternal health services in Bulgaria coexists with low maternal preparedness for infant care. Quantitative data describe the extent of this gap but offer limited insight into underlying causes, which qualitative evidence may help explain. This study integrates quantitative and qualitative evidence to examine both the extent and mechanisms of gaps in maternal preparedness for infant care.

Methods

A mixed-methods design was applied. Quantitative data were obtained from a survey conducted in 2023 among 249 mothers of children under one year, using a 30-item questionnaire assessing counselling, support and preparedness. Qualitative data were derived from semi-structured interviews with 30 Roma women across three generations and analysed thematically. Findings were integrated to identify converging patterns between measured outcomes and lived experiences.

Results

Survey findings indicated high utilisation of prenatal care (97%) but limited counselling on newborn care (75.9%) and low maternal preparedness (25%). Qualitative findings provided explanatory context, describing reduced postnatal support, limited communication and reliance on family networks. Across both data sources, gaps in guidance and continuity of care emerged consistently, with qualitative accounts illustrating how insufficient system support is compensated for at the family level. Lower-educated mothers were less likely to receive counselling (p = 0.002), indicating socio-demographic inequalities in access to information.

Conclusions

Combining quantitative and qualitative evidence reveals both the extent and mechanisms of insufficient maternal preparedness. While survey data quantify gaps in counselling and preparedness, qualitative findings explain how these gaps are experienced and managed in practice. Addressing discontinuities in care and strengthening communication and postnatal support are essential to improve maternal preparedness and reduce health inequalities.

Key messages

• Quantitative data show the extent of limited maternal preparedness, while qualitative evidence explains why it occurs.

• Integrating quantitative and qualitative evidence reveals mechanisms of gaps in maternal support that are not captured by service coverage indicators.