38 Community perceptions of hypertensive disorders of pregnancy, health-seeking behaviors and pathways to seeking care in bangladesh

Abstract

Introduction Hypertensive disorders of pregnancy (HDP) are major contributors to maternal and neonatal mortality, morbidity and disability. Despite numerous efforts to reduce preventable maternal and neonatal death, between 5000 and 6000 women die from pregnancy-related causes each year in Bangladesh, 20% of which are due to pre-eclampsia and eclampsia (PE/E); the second largest cause of maternal deaths. Objectives The objective was to assess community awareness, beliefs and experiences around HDP, experiences of PE/E survivors and pathways of seeking care for HDP. Methods Data were separated from a larger survey conducted to understand the exact situation of policy, programs, facility readiness and community perceptions about PE/E in Bangladesh. Eight focus group discussions (FGDs) were conducted with married men ( n = 4) and married women of child bearing age ( n = 4) from four districts. In total, 72 participants (36 male and 36 female) participated. In addition, 22 in-depth interviews were conducted with PE/E survivors. Data were collected using hand-written notes, supported by tape recordings that were transcribed for content and thematic analysis using Atlas-ti. Findings from FGDs and IDIs were triangulated to complement other findings. Results There are many beliefs and misconceptions around pregnancy in the communities. Pregnant women cannot go outside, eat certain foods, and many are not allowed to take modern medicine. Community members lack knowledge on danger signs during pregnancy, particularly high blood pressure. Most male and female FGD informants reported bleeding, convulsion, retained placenta, and ruptured membranes as the most serious problems during pregnancy; few female participants mentioned high blood pressure. Only 3 female and 2 male FGD participants had heard about PE/E. Health-seeking behaviors of pregnant women follow a pattern where mothers-in-law and/or husbands initially consult with the imam of a mosque, traditional healer, or village doctor for any problems and visit a facility when the problem becomes very serious. A majority of informants reported that the decision to seek health care outside the home and visit a provider is made by mothers-in-law and/or husbands. One of the female informant mentioned, “mother-in-law’s say we did not visit hospitals during our time, we had no problems. It is not needed now as well” while a male informants mentioned, “it’s a women matter, my mother will know what to do.” Most of the PE/E survivors reported that they do not get proper, timely, or adequate treatment at lower level facilities and are referred from one facility to another. Other factors that negatively affect the health-seeking behavior of PE/E patients include: lack of money to bear out of pocket expenses, lack of transportation, distance to hospital, lack of proper attention at the hospital, and lack of qualified providers. Conclusions Many factors that are beyond a woman’s control can negatively impact pregnancy health-seeking behavior. These factors are compounded by myths and misconceptions. Educational initiatives should target knowledge gaps by incorporating cultural understandings of HDP and advocacy efforts should call for improvement in facility practices particularly for PE/E.