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Why do women not adhere to advice on maternal referral in rural Tanzania?: Narratives of women and their family members
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili University of Health and Allied Sciences, School of Medicine, Department of Obstetrics and Gynaecology.ORCID iD: 0000-0002-8090-3298
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Aga Khan University, School of Nursing and Midwifery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Norwegian University of Science and Technology, NTNU, Department of Public Health and Nursing; St Olav's Hospital, Department of Obstetrics and Gynaecology.
2017 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1364888Article in journal (Refereed) Published
Abstract [en]

Background: In most low-income countries, many women with high-risk pregnancies and complications do not reach the referral hospitals despite the provision of referral advice.

Objective: To explore how antenatal maternal referral advice is understood and handled in a rural Tanzanian community.

Methods: Individual in-depth interviews were conducted with six women who did not go to hospital and 13 people who were involved in the referral advice. Narrative analysis was used to describe and create meanings out of the decision-making process.

Results: In all interviews, not following the referral advice was greatly influenced by close family members. Three main traits of how referral advice was understood emerged: convinced referral is not necessary, accepting referral advice but delayed by others, and passive and moving with the wind. The main reasons given for declining the referral advice included discrediting midwives' advice, citing previous successful deliveries despite referral advice; being afraid of undergoing surgery; lack of support for care of siblings at home; and high costs incurred during referral.

Conclusions: Declining maternal referral advice centred around the pregnant women's position and their dependence on the family members around them, with a decreased ability to show autonomy. If they were socially and economically empowered, women could positively influence decision making during maternal referrals.

Place, publisher, year, edition, pages
2017. Vol. 10, no 1, article id 1364888
Keywords [en]
Health systems, gender, community, developing, countries, social capital, maternal referrals, rural
National Category
Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health
Identifiers
URN: urn:nbn:se:uu:diva-334933DOI: 10.1080/16549716.2017.1364888ISI: 000408680200001PubMedID: 28856975OAI: oai:DiVA.org:uu-334933DiVA, id: diva2:1161878
Funder
Sida - Swedish International Development Cooperation AgencyAvailable from: 2017-12-01 Created: 2017-12-01 Last updated: 2018-01-13Bibliographically approved

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Pembe, AndreaMbekenga, Columba K.Olsson, PiaDarj, Elisabeth
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