Abstract
Maternal and neonatal morbidity and mortality tend to decrease if referral advice during pregnancy is utilized appropriately. This study explores the reasons for nonadherence to referral advice among high-risk pregnant women. A qualitative study was conducted in Morang District, Nepal. A phenomenological inquiry was used. Fourteen participants were interviewed in-depth. High-risk women who did not comply with the referral to have a hospital birth were the study participants. Participants were chosen purposively until data saturation was achieved. The data were generated using thematic analysis. Preference of homebirth, women’s diminished autonomy and financial dependence, conditional factors, and sociocultural factors were the four major themes that hindered hospital births. Women used antenatal check-ups to reaffirm normalcy in their current pregnancies to practice homebirth. For newly-wed young women, information barriers such as not knowing where to seek healthcare existed. The poorest segments and marginalized women did not adhere to referral hospital birth advice even when present with high-risk factors in pregnancy. Multiple factors, including socioeconomic and sociocultural factors, affect women’s decision to give birth in the referral hospital. Targeted interventions for underprivileged communities and policies to increase facility-based birth rates are recommended.
Highlights
The World Health Organization has defined the concept of compliance as the accomplishment of certain behaviors, such as taking prescribed medication, following a diet, executing lifestyle changes, and following the recommendations provided by healthcare providers [1]
Giving birth at the birthing center or homebirth instead of referral hospital after referral advice from the primary care level was regarded as nonadherence in this study
An in-depth interview was conducted with 14 postpartum women who were identified as having experienced high-risk pregnancies
Summary
The World Health Organization has defined the concept of compliance as the accomplishment of certain behaviors, such as taking prescribed medication, following a diet, executing lifestyle changes, and following the recommendations provided by healthcare providers [1]. Thaddeus and Maine’s three delays model is the foundational model for studying delay in compliance [2]. According to this model, nonadherence to a referral for facility-based birth can be considered the first delay in decision making to seek care [2]. The referral process represents the handing over of care from a general practitioner to a specialist [3]. The adherence process requires both the patient and the healthcare providers’ involvement and good communication among all involved parties
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