Abstract
Introduction
Women who are referred following emergency obstetric complications tend to experience several challenges while accessing obstetric care. This study was conducted to explore the perceptions and experiences of women who were referred following emergency obstetric complications in Eastern Uganda.
Methods and materials
We conducted 17 in-depth interviews with postpartum mothers who were referred to Mbale Regional Referral Hospital (MRRH). We explored the experiences and perceptions of women regarding the referral system, including their response to being referred, what they liked and disliked about being referred, and the challenges that they faced during referral. The study received ethical clearance and used thematic data analysis.
Results
We derived five themes from the data: 1) the facilitators of referral, 2) the challenges of reaching the referral site, 3) the quality of care in the referring facilities, 4) good quality of care in the referral facility, and 5) response to referral and appraisal of the referral system. An early decision to refer, informing the receiving facilities of the incoming referrals, and accompanying the woman to the referral site facilitated the referral of women. Women faced difficulty reaching the referral site because of financial constraints, poor roads, long distances, multiple referrals, and the use of inappropriate means of transport. Women experienced poor quality of care in the form of abuse and disrespectful maternity care, shortage of medicines and supplies, and unavailability of essential services in the referring facilities. Care in the receiving facility was perceived to be of good quality related to warm reception, immediate care on arrival, availability of services, and respectful and responsive healthcare providers. Response to being referred varied from being fearful, and anxious to reluctance and willingness to comply with referral advice. Overall, women positively appraised the referral system.
Conclusions
Women experienced challenges with referral systems related to inadequate staffing, poor quality of care, shortage of medicines and services, and difficulty reaching the referral site. Experiences and perceptions shaped how women responded to and appraised the referral system. Strengthening the quality of care in the referring facilities is critical in reducing unnecessary referrals and promoting positive birth outcomes.