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

Abstract

Background: In most low-income countries, many women with high-risk pregnancies and complications do not reach the referral hospitals despite the provision of referral advice. Objective: To explore how antenatal maternal referral advice is understood and handled in a rural Tanzanian community. Methods: Individual in-depth interviews were conducted with six women who did not go to hospital and 13 people who were involved in the referral advice. Narrative analysis was used to describe and create meanings out of the decision-making process. Results: In all interviews, not following the referral advice was greatly influenced by close family members. Three main traits of how referral advice was understood emerged: convinced referral is not necessary, accepting referral advice but delayed by others, and passive and moving with the wind. The main reasons given for declining the referral advice included discrediting midwives’ advice, citing previous successful deliveries despite referral advice; being afraid of undergoing surgery; lack of support for care of siblings at home; and high costs incurred during referral. Conclusions: Declining maternal referral advice centred around the pregnant women’s position and their dependence on the family members around them, with a decreased ability to show autonomy. If they were socially and economically empowered, women could positively influence decision making during maternal referrals.

Quality and women’s satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: A systematic review 

“…Limited decision-making capacity of women, fear of blood transfusion and fear to die in higher level facilities have been noted by similar studies in sSA where men, in-laws and elders decide whether women are allowed to travel [78][79][80]. In rural Uganda, women enduring maternity pain were considered brave since pregnancy was perceived as a test of endurance [81].…”

The quality of and women’s satisfaction with maternal referral practices in Sub-Saharan African low and lower-middle income countries: A systematic review

“…Limited decision-making capacity of women, fear of blood transfusion and fear of death at higher level health facilities have been noted by similar studies in SSA where men, in-laws and elder decide whether a women is allowed to travel [80][81][82]. In rural Uganda, women who could endure obstetric pain were considered brave since pregnancy was perceived as a test of endurance [83].…”

The quality of and women’s satisfaction with maternal referral practices in Sub-Saharan African low and lower-middle income countries: A systematic review

“…Limited decision-making capacity of women, fear of blood transfusion and fear to die in higher level health facilities have been noted by similar studies in SSA where men, in-laws and elder decide whether women are allowed to travel [77][78][79]. In rural Uganda, women who could endure obstetric pain were considered brave since pregnancy was perceived as a test of endurance [80].…”