Exploring women’s experience of healthcare use during pregnancy and childbirth to understand factors contributing to perinatal deaths in Pakistan: A qualitative study

Abstract

Understanding key healthcare system challenges experienced by women during pregnancy and birth is crucial to scale up available interventions and reduce perinatal mortality. A community perspective about preferences and experience of care during this period can be used to improve community-based programs to reduce perinatal mortality. Using a qualitative exploratory approach, we examined women's experience of perinatal loss, aiming to understand the main factors, as perceived and experienced by women, leading to perinatal loss. Qualitative in-depth Interviews were conducted with 25 mothers with a recent perinatal loss, three family members, six healthcare officials, and two focus group discussions with 17 lady health workers. Data were analysed using inductive and deductive coding, by thematic analysis. Our findings revealed three distinct but interrelated themes, which include: 1) poor access to care during pregnancy and birth, 2) unavailability of appropriate healthcare services, and 3) poor quality of care during pregnancy and birth. Women frequently delayed seeking formal care around birth because of delays by themselves, their family members, or the local traditional birth attendants who frequently induced births at women's homes without recognising the dangers to the mothers or their babies. Preference for private care was common, however they often could not bear the cost of care when they needed caesarean section or in-patient care for their sick newborns because these services were absent in public health facilities of the district. Referral to the regional tertiary care hospital was often not officially arranged leading to risky births in small and crowded private clinics. Women's views about negative staff attitudes and the lack of attention given to them in public health facilities highlighted a lack of quality and respectful antenatal care. Improvement in women's access to essential care during pregnancy and around birth, availability of emergency obstetric and newborn care, improving the quality of maternal and newborn care in both public and private health facilities at the district level might reduce perinatal mortality in Pakistan.

Exploring gestational age, and birth weight assessment in Thatta district, Sindh, Pakistan: Healthcare providers’ knowledge, practices, perceived barriers, and the potential of a mobile app for identifying preterm and low birth weight

“…In a study from Rajasthan, India [ 16 ], HCPs used a combination of LMP, fundal height, and ultrasound for GA assessment. Some relied on LMP or fundal height, despite their unreliability [ 17 ], while others used fundal height to confirm LMP. Antenatal ultrasounds were not offered directly, and referrals were made to higher-level facilities in the second or third trimester [ 18 ].…”

Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi

“…This is even more crucial for health facilities where midwives are involved as frontline staff in providing antenatal and intrapartum care [49]. Community factors, such as delay in seeking care and lack of trust in healthcare facilities, were also significant contributors to adverse outcomes, particularly in cases of perinatal asphyxia and preterm birth complications [50]. Addressing both health systems and community factors through comprehensive interventions and community engagement to improve maternal and neonatal health outcomes is pivotal to address the underline causes [51].…”

Associations of hypertension and antenatal care-seeking with perinatal mortality: A nested case-control study in rural Bangladesh

“…Possible explanations could be related to poor quality of care by the health care provider, late onset of care-seeking, or weak referral systems once complications were identified. [31][32][33][34] Women with a history of hypertension predating pregnancy and who experienced a perinatal death sought care late in their pregnancies, possibly spurred by the onset of hypertension-induced complications. Further qualitative research is needed to understand why women with pregnancies complicated by hypertension, including women with a known history of disease, did not have more frequent contact, as per national guidelines, with the health care system in order to effectively manage their high-risk pregnancy.…”