Abstract
BackgroundPre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care.MethodsWe conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model.ResultsSurvivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy.ConclusionsEngaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care.
Highlights
Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally
All three countries have high maternal mortality ratios (MMR), rates have been falling in Ethiopia while they remain almost static in Haiti and Zimbabwe. (Table 1) The Ethiopian study area included Meskan and Sodo districts in the Gurage Zone, Southern Nations, Nationalities and People’s Region (SNNPR) approximately 130 km south of Addis Ababa
We found that symptoms and problems associated with pre-eclampsia were interpreted in different ways within and across settings
Summary
Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of lifesaving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care. Maternal health inequities remain an urgent global concern despite improvements over recent decades [1]. Preeclampsia is a leading cause of maternal and perinatal. A complex and variable pregnancy-specific, multisystem disease, the aetiology of pre-eclampsia remains to be fully elucidated [4]. Pre-eclampsia can be unheralded and unpredictable, contributing to uncertainty for women and care providers. Visual disturbance, abdominal pain, significant swelling including of the hands and face, or may be asymptomatic. Symptoms do not necessarily correlate with severity and deterioration can be rapidly progressive
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