Why women choose to to seek facility-level obstetrical care in rural Guatemala: A qualitative study

Abstract Objective The majority of indigenous Guatemalan women give birth at home with traditional birth attendants (TBAs), and maternal mortality rates are high ( Ministerio de Salud, 2017 ). Our objective was to better understand decision-making around whether to remain in the home or to seek facility-level care for obstetric complications. Methods This study was a qualitative analysis using semi-structured interviews in a Maya population in the Western Highlands of Guatemala who received prenatal care between April 2017 and December 2018. We used qualitative interviews with women who were identified as medically high-risk and needing facility-level care, offered assistance with acquiring such care, and yet declined this option. Women interviewed were connected to a primary care organization called Maya Health Alliance, through care with TBAs involved in a program utilizing a smartphone-based decision support application to identify maternal and neonatal complications of pregnancy. Interviews were analyzed using Dedoose ( www.dedoose.com ). Deductive and inductive analysis was performed. Results Barriers to care included a disagreement between the respondent and TBA about indications for facility care, fear of hospital care, concerns about the quality of hospital care, logistical obstacles, and lack of control; and they were more often described by respondents who had previous healthcare experiences. Therapeutic misalignment occurred more with conditions perceived to be less severe. Participants described a balancing of fears and apprehensions against concerns of low quality and disrespectful maternity care, and in the setting of emergent conditions, disregarded barriers that were often described as inhibiting non-urgent obstetric care. Conclusions The decision to engage in medical care in this population of Maya women involves a weighing of the perception of seriousness of the medical complication against fears of facility level care and concerns of a poor quality of care.