Referral care for high-risk pregnant women in rural Rajasthan, India: a qualitative analysis of barriers and facilitators

Abstract

Objective To qualitatively assess the barriers and facilitators to uptake of referral services amongst high-risk pregnant women in rural Rajasthan. Methods A purposive sample of pregnant women with high-risk conditions requiring referral follow-up care (severe hypertension, moderate anemia, and severe anemia) were considered for inclusion. In-depth individual interviews were conducted in the local dialect, Mewari. Interviews were transcribed, coded, and organized for thematic generation as per the analytical framework described in the socio-ecological model. Results 19 high risk pregnant women of low socioeconomic backgrounds across 15 villages were interviewed. Barriers to referral care included lack of transportation, household responsibilities, and limited awareness, education, and social support. The most prominent barrier was lack of accompaniment to the referral center by a family member or health worker. Facilitators included available husbands, engaged heath workers, supportive neighbors, and other female family members who shared past experiences. Conclusions Social support at the interpersonal and community level was key to overcoming referral care barriers faced by high-risk pregnant women in rural Rajasthan. Interventions that enhance social support may improve uptake of referral care services by high-risk pregnant women.

Addressing barriers in utilization and provisioning of obstetric care services (OCS) in India: A mixed method systematic review

“…A poor economic status was a major hindrance in accessing OCS [1,8,9,33,40,42,45,55,56]. High costs for availing the OCS services, such as cost of institutional delivery [15,17,25,33,35,40,46,55,62] and transportation cost [2,14,29,62] were other important barriers to service utilization. It was predominantly found in women's stand on the intersection of caste and poverty [25,33,35,40].…”

“…High costs for availing the OCS services, such as cost of institutional delivery [15,17,25,33,35,40,46,55,62] and transportation cost [2,14,29,62] were other important barriers to service utilization. It was predominantly found in women's stand on the intersection of caste and poverty [25,33,35,40]. Additionally, the cost of referral services, including travel and subsistence cost, was major barrier to delay or unable to reach a referred health facility [1,9,33,35].…”

“…It was predominantly found in women's stand on the intersection of caste and poverty [25,33,35,40]. Additionally, the cost of referral services, including travel and subsistence cost, was major barrier to delay or unable to reach a referred health facility [1,9,33,35]. In this regard, qualitative studies revealed that the cost of services was a key determining factor for the majority of women when deciding between home birth and institutional delivery [17,35,40].…”

“…Previous studies documented that poor quality of treatment [4,17,25,26,28,33,34,35,40,41,44,49,53,59] and the non-cooperative attitude of health professionals were responsible for women and their families in hesitating to seek OCS [14,20,25,44,53,54]. Previous studies also reveal that disrespectful behaviors of health professionals toward pregnant women are major barriers to institutional deliveries [20,44,53].…”

“…Moreover, in India OCS barriers are mostly categorized on the demand and supply sides [12]. Lack of knowledge and awareness, lack of women's autonomy, traditional and alternative practices, fear and stigma, in uence of family members, long distance of health facility, nancial constraints, poor quality of health service, and poor attitudes of medical staff have been consistently reported as signi cant demand-side barriers [4,29,[32][33][34][35]. Shortage of drugs, medical equipment, human resources, and lack of physical infrastructure are prominent barriers in supply side [3,12,25,36].…”