An Ethnographic Study of Therapeutic Pathways and Obstacles in Botswana's Maternal Healthcare System

Maternal healthcare systems in sub-Saharan Africa face complex challenges. Botswana’s system encounters persistent obstacles within its specific socio-cultural and logistical context, affecting pathways to care for pregnant women. This study aimed to ethnographically map therapeutic pathways for maternal care in Botswana. Its objective was to identify and analyse the systemic, cultural and logistical obstacles that shape women’s experiences and outcomes. A multi-sited ethnographic study was conducted in selected urban and rural health districts. Data collection involved participant observation in clinics and maternity wards, in-depth interviews with women seeking antenatal and postnatal care, and semi-structured interviews with healthcare professionals and administrators. Data were analysed using thematic analysis. A primary finding was the theme of ‘medicinal intermittency’, where inconsistent supply of essential medicines frequently disrupted care. This was compounded by communication gaps between providers and patients, often rooted in differing cultural understandings of pregnancy and authority. Logistical challenges in rural areas significantly extended therapeutic pathways, increasing indirect costs and time burdens for women. The maternal healthcare system in Botswana is characterised by fragmented therapeutic pathways. Structural obstacles, embedded in institutional and intercultural communication practices, frequently undermine clinical protocols. Recommendations include strengthening supply chain management with community-level monitoring, implementing structured intercultural communication training for healthcare providers, and developing more flexible care models for rural populations to reduce access barriers. Maternal health, Ethnography, Botswana, Therapeutic pathways, Health systems, Access to medicines, Intercultural communication This study provides a detailed ethnographic account of how systemic, logistical and cultural factors intersect to shape maternal healthcare delivery and patient experience in Botswana.