Perceptions and experiences of women referred during obstetric complications in Eastern Uganda: A qualitative study

Women, who are referred, 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. We conducted 17 in-depth interviews with referrals. We explored women's responses to being referred, what they liked and disliked about being referred, and their challenges during referral. We identified five themes from the data: 1) the facilitators of the referral system, 2) barriers during obstetric referral, 3) the quality of care in the lower-level health 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, communication between health facilities, and accompanying the woman to the higher-level referral site facilitated the referral process. Financial constraints, poor roads, long distances, multiple referrals, and the use of inappropriate modes of transport were the main barriers to referral. Women experienced disrespect, shortages of medicines and supplies, and unavailability of essential services in the lower-level facilities. The referral site was perceived to provide good quality care for referrals because of warm reception, immediate care, availability of services, and respectful and responsive healthcare providers. Women were fearful and reluctant to be referred because of distant referral sites, failure to recognize obstetric complications, and fear of cesarean section and mistreatment in the referral site. Some women were willing and complied to be referred because of their confidence of care in the referral site, and their ability to perceive obstetric complications. Women experienced challenges with referral systems from poor quality of care, and difficulty reaching the referral site. These experiences and perceptions shaped how women responded to and appraised the referral system. Strengthening the quality of care in lower-level health facilities is critical in improving the referral system.