Pembe Andrea B, Mbekenga Columba K, Olsson Pia, Darj Elisabeth
a Department of Obstetrics and Gynaecology, School of Medicine , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania.
b Department of Women's and Children's Health , International Maternal and Child Health (IMCH), Uppsala University , Uppsala , Sweden.
Glob Health Action. 2017;10(1):1364888. doi: 10.1080/16549716.2017.1364888.
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.
To explore how antenatal maternal referral advice is understood and handled in a rural Tanzanian community.
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.
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.
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.
在大多数低收入国家，尽管提供了转诊建议，但许多患有高危妊娠和并发症的妇女仍无法抵达转诊医院。
探讨坦桑尼亚农村社区如何理解和处理产前孕产妇转诊建议。
对6名未前往医院的妇女和13名参与转诊建议的人员进行了个人深度访谈。采用叙事分析来描述决策过程并从中提炼意义。
在所有访谈中，不遵循转诊建议很大程度上受到亲密家庭成员的影响。出现了对转诊建议理解的三个主要特点：确信无需转诊、接受转诊建议但被他人耽搁、被动跟风。拒绝转诊建议的主要原因包括怀疑助产士的建议、尽管有转诊建议但称此前分娩成功；害怕接受手术；在家中缺乏照顾兄弟姐妹的支持；以及转诊期间产生的高额费用。
拒绝孕产妇转诊建议主要围绕孕妇的地位及其对周围家庭成员的依赖，自主能力下降。如果妇女在社会和经济上获得赋权，她们可以在孕产妇转诊期间对决策产生积极影响。
