Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
The University of Sydney, Sydney School of Public Health, Camperdown, New South Wales, Australia.
PLoS One. 2020 May 7;15(5):e0232823. doi: 10.1371/journal.pone.0232823. eCollection 2020.
Understanding key healthcare system challenges experienced by women during pregnancy and birth is crucial to scale up available interventions and reduce perinatal mortality. A community perspective about preferences and experience of care during this period can be used to improve community-based programs to reduce perinatal mortality. Using a qualitative exploratory approach, we examined women's experience of perinatal loss, aiming to understand the main factors, as perceived and experienced by women, leading to perinatal loss. Qualitative in-depth Interviews were conducted with 25 mothers with a recent perinatal loss, three family members, six healthcare officials, and two focus group discussions with 17 lady health workers. Data were analysed using inductive and deductive coding, by thematic analysis. Our findings revealed three distinct but interrelated themes, which include: 1) poor access to care during pregnancy and birth, 2) unavailability of appropriate healthcare services, and 3) poor quality of care during pregnancy and birth. Women frequently delayed seeking formal care around birth because of delays by themselves, their family members, or the local traditional birth attendants who frequently induced births at women's homes without recognising the dangers to the mothers or their babies. Preference for private care was common, however they often could not bear the cost of care when they needed caesarean section or in-patient care for their sick newborns because these services were absent in public health facilities of the district. Referral to the regional tertiary care hospital was often not officially arranged leading to risky births in small and crowded private clinics. Women's views about negative staff attitudes and the lack of attention given to them in public health facilities highlighted a lack of quality and respectful antenatal care. Improvement in women's access to essential care during pregnancy and around birth, availability of emergency obstetric and newborn care, improving the quality of maternal and newborn care in both public and private health facilities at the district level might reduce perinatal mortality in Pakistan.
了解妇女在妊娠和分娩期间所经历的关键医疗保健系统挑战，对于扩大现有干预措施和降低围产期死亡率至关重要。从社区角度了解妇女在这一期间的偏好和护理体验，可以用来改善基于社区的方案，以降低围产期死亡率。本研究采用定性探索性方法，考察了妇女的围产期死亡经历，旨在了解导致围产期死亡的主要因素，这些因素是妇女感知和经历到的。研究对 25 名近期经历围产期死亡的母亲、3 名家庭成员、6 名医疗保健官员以及 2 次有 17 名女性保健工作者参加的焦点小组讨论进行了深入的定性访谈。使用归纳和演绎编码进行数据分析，并进行主题分析。研究结果揭示了三个不同但相互关联的主题，包括：1）妊娠和分娩期间难以获得护理，2）缺乏适当的医疗保健服务，3）妊娠和分娩期间护理质量差。妇女在分娩前后常常因自身、家庭成员或当地传统助产士的延误而延迟寻求正规护理，这些传统助产士经常在妇女家中催生，而没有意识到对母亲或婴儿的危险。对私人护理的偏好很普遍，但当她们需要剖腹产或需要为患病的新生儿提供住院治疗时，她们往往无法承受护理费用，因为这些服务在该地区的公共卫生设施中是不存在的。向地区三级保健医院转诊通常没有正式安排，导致在小型和拥挤的私人诊所中进行有风险的分娩。妇女对工作人员负面态度的看法以及她们在公共卫生设施中得不到关注，突显了缺乏优质和尊重的产前护理。改善妇女在妊娠和分娩期间获得基本护理的机会、提供紧急产科和新生儿护理、改善公共和私人卫生设施中产妇和新生儿护理的质量，可能会降低巴基斯坦的围产期死亡率。
