Why Do At-Risk Mothers Fail to Reach Referral Level? Barriers beyond Distance and Cost

Abstract

In southern Tanzania, few high-risk pregnancies are channeled through antenatal care to the referral level. We studied the influences that make pregnant women heed or reject referral advice. Semi-structured interviews with sixty mothers-to-be, twenty-six health workers and six key-informants to identify barriers to use of referral level were conducted. Expert-defined risk-status was found to have little influence on a woman's decision to seek hospital care. Besides well known geographical and financial barriers, we found that pregnant women have different perceptions and interpretations of danger signs. Furthermore, rural women avoid the hospital because they fear discrimination. We conclude that a more individualised antenatal consultation could be provided by taking into account women's perception of risk and their explanatory models. Hospital services should be reorganised to address rural women's feelings of fear and insecurity.

Why do women not adhere to advice on maternal referral in rural Tanzania? Narratives of women and their family members

“…In agreement with previous studies, these results showed that pregnant women and other actors have ways of evaluating the risks and complications needing referral which differ from the biomedical perspective of the health workers [11,13]. The actors’ perception was that a pregnant woman who is advised to go and deliver in the hospital should go only when she has failed to deliver at the dispensary, despite being aware of the increased costs and the risk that the mother may die or have a permanent disability.…”

“…The Three Delay Model by Thaddeus and Maine [9] illustrates studies investigating barriers to adherence to referral advice for hospital delivery in rural Tanzania, including financial constraints, difficulty in accessing transport, poor quality of care and shortage of staff [5,10–12]. However, another study in southern Tanzania reported that pregnant women do not accept referral because they perceive that they will be separated from their families and fear the unfamiliar environment of the hospital [13]. Therefore, there is a need to explore the complex influences in the social environment that may prevent women in rural Tanzania adhering to the referral advice given by health workers.…”

Determinants of utilisation of maternal care services after the reduction of user fees: A case study from rural Burkina Faso

“…Understanding the role played by religion and ethnicity in shaping women's access to maternal care, however, is beyond the scope of this paper and requires additional qualitative inquiry. A plausible explanation, to be confirmed by future research, is that both access to social networks and perceptions of the potential risks and benefits derived from using medical care differ across religious and ethnic groups [70].…”

Acceptability of focused antenatal care by antenatal clinic attendees in Obio Cottage Hospital, Port Harcourt, Nigeria

“…The majority of the acceptors in Enugu (65%) gave convenience as the reason for accepting reduced visits [26]. Long waiting time in antenatal care clinic is associated with dissatisfaction with care [27][28][29]. An antenatal care practice that still meets the goal of antenatal care without adverse maternal or fetal outcome would save women's time.…”