Abstract
BackgroundRwanda 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.MethodsA 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.ResultsThe 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.ConclusionImproved 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.
Highlights
Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy
Despite decades of global efforts focusing on decreasing maternal deaths, 800 women still die each day with approximately two-thirds of these deaths in sub-Saharan Africa alone [1, 2]
Restrictive abortion laws significantly increases risks of morbidities and mortalities, and an estimated 18 % of all maternal deaths in eastern Africa are due to unsafe abortions [3, 4]
Summary
Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. Maternal mortality ratio has decreased from 487 in 2010 to 210 in 2015, and facility-based deliveries have increased from 69 % in 2010 to 91 % in 2015 [5, 6]. Reasons for this increase may be due to the rule that imposes a fine if women deliver at home, the outlawing of traditional birth attendants or the availability of health insurance [7, 8].
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