title: Physicians' experiences and views on the role of obstetric ultrasound in rural and urban Rwanda: a qualitative study.
abstract: To explore Rwandan physicians' experiences and views on the role of obstetric ultrasound in clinical management of pregnancy, and in situations where maternal and fetal health interests conflict.
  
  
  
  Physicians (n = 19) in public and private health facilities in urban and rural Rwanda were interviewed in 2015 as part of the CROss-Country Ultrasound Study (CROCUS). Data were analysed qualitatively.
  
  
  
  Ultrasound was described as an important tool in maternity care. Availability and quality of equipment varied across sites, and considerable disparities in obstetric ultrasound utilisation between rural and urban areas were described. The physicians wanted more ultrasound training and saw the potential for midwives to perform basic scans. Information about fetal sex and well-being was described as women's main expectations of ultrasound. Although women's right to autonomy in pregnancy was supported in principle by participating physicians, fetal rights were sometimes seen as needing physician 'protection'.
  
  
  
  There appears to be increasing use and demand for obstetric ultrasound in Rwanda, particularly in urban areas. It seems important to monitor this development closely to secure wise and fair allocation of scarce obstetric expertise and resources and to prevent overuse or misuse of ultrasound. Raising awareness about the benefits of all aspects of antenatal care, including ultrasound may be an important step to improve pregnant women's uptake of services. Increased opportunities for formal ultrasound training, including the training of midwives to perform basic scans, seem warranted. Moreover, in parallel with the transition to more medico-technical maternity care, a dialogue about maternal rights to autonomy in pregnancy and childbirth is imperative.
authors.affiliation: Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.|Judith Lumley Centre, La Trobe University, Melbourne, Australia.
authors.forename: Kristina
authors.initials: K
authors.lastname: Edvardsson
authors.affiliation: College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ntaganira
authors.affiliation: Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Åhman
authors.affiliation: Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.|College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda.
authors.forename: Jean Paul Semasaka
authors.initials: JP
authors.lastname: Sengoma
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne, Australia.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Small
authors.affiliation: Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Mogren
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D005333:Fetus; D006801:Humans; D008297:Male; D000068097:Maternal Health; D008875:Middle Aged; D008880:Midwifery / Q000193:education; D009042:Motivation; D009774:Obstetrics; D028701:Patient Rights; D026684:Personal Autonomy; D010820:Physicians; D011247:Pregnancy; D011248:Pregnancy Complications; D011295:Prenatal Care; D036301:Qualitative Research; D012424:Rural Population; D012432:Rwanda; D012737:Sex Factors; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data; D014505:Urban Population
keywords: Estudios cualitativos; Mujeres embarazadas; Obstetricia; Ruanda; Rwanda; Ultrasonido obstétrico; femmes enceintes; obstetric ultrasound; obstetrics; obstétrique; pregnant women; qualitative studies; échographie obstétricale; études qualitatives