Beyond the numbers of maternal near-miss in Rwanda – a qualitative study on women’s perspectives on access and experiences of care in early and late stage of pregnancy

Abstract

Background: Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. We explored care-seeking and experiences of maternity care among women who suffered a near-miss event during either the early or late stage of pregnancy, and identified potential health system limitations or barriers to maternal survival in this setting. Methods: A framework of Naturalistic Inquiry guided the study design and analysis, and the 'three delays' model facilitated data sorting. Participants included 47 women, who were interviewed at three hospitals in Kigali, and 14 of these were revisited in their homes, from March 2013 to April 2014. Results: The women confronted various care-seeking barriers depending on whether the pregnancy was wanted, the gestational age, insurance coverage, and marital status. Poor communication between the women and healthcare providers seemed to result in inadequate or inappropriate treatment, leading some to seek either traditional medicine or care repeatedly at biomedical facilities. Conclusion: Improved service provision routines, information, and amendments to the insurance system are suggested to enhance prompt care-seeking. Additionally, we strongly recommend a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy.

Regional disparities in antenatal care utilization in Indonesia

“…In general, it can be explained that the more educated a person is, the easier it is to receive new health information and understand the dangers or risks of behaviors that have an impact on health [38][39][40]. Education has also been shown to play a role in one's perception of the quality of health services [41,42]. Furthermore, improving education is generally accepted as one of the determinants of life expectancy [43].…”

Regional Disparities of Antenatal Care Utilization in Indonesia

“…In general, it can be explained that the more educated a person is, the easier it is to receive new health information, while at the same time being able to understand the dangers or risks of behaviors that have an impact on health [36][37][38]. Education has also been shown to play a role in one's perception of the quality of health services [39,40]. Furthermore, improving education is generally accepted as one of the determinants of life expectancy [41].…”

Experiencias de mujeres sobrevivientes a morbilidad materna extrema en México, un estudio cualitativo desde el modelo de las tres demoras

“…La Organización Mundial de la Salud (OMS) recomienda que sean llevados a cabo más estudios con mujeres sobrevivientes de morbilidad materna extrema, puesto que trabajar con ellas posibilita acceder a un mayor número de casos para analizar, entendiendo de que por cada muerte materna se tiene un registro de cerca de 20 sobrevivientes de morbilidad materna extrema 2 . En este sentido, mientras en África y Asia han comenzado a impulsarse trabajos de investigación con sobrevivientes de morbilidad materna extrema 3,4,5,6,7 , en América Latina la investigación ha continuado centrándose principalmente en las muertes maternas.…”

“…Un estudio realizado en Asia documentó que la segunda demora fue la más relevante, asociada con la carencia de programas de protección de salud 3 . Otro estudio llevado a cabo en Ruanda señaló también la segunda demora como la más relevante, sin embargo, las razones asociadas fueron la ausencia de apoyos en materia de protección en salud, pero sobre todo, el temor de las mujeres para acercarse a los servicios sanitarios por la criminalización del aborto 5 .…”