title: Beyond the numbers of maternal near-miss in Rwanda - a qualitative study on women's perspectives on access and experiences of care in early and late stage of pregnancy.
abstract: Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. We explored care-seeking and experiences of maternity care among women who suffered a near-miss event during either the early or late stage of pregnancy, and identified potential health system limitations or barriers to maternal survival in this setting.
  
  
  
  A framework of Naturalistic Inquiry guided the study design and analysis, and the 'three delays' model facilitated data sorting. Participants included 47 women, who were interviewed at three hospitals in Kigali, and 14 of these were revisited in their homes, from March 2013 to April 2014.
  
  
  
  The women confronted various care-seeking barriers depending on whether the pregnancy was wanted, the gestational age, insurance coverage, and marital status. Poor communication between the women and healthcare providers seemed to result in inadequate or inappropriate treatment, leading some to seek either traditional medicine or care repeatedly at biomedical facilities.
  
  
  
  Improved service provision routines, information, and amendments to the insurance system are suggested to enhance prompt care-seeking. Additionally, we strongly recommend a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy.
authors: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Akademiska Sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden. jessica.pafs@kbh.uu.se.
authors: Jessica
authors: J
authors: Påfs
authors: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Akademiska Sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden.|Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, University of Rwanda, P.O. Box 217, Butare, Huye, Rwanda.
authors: Aimable
authors: A
authors: Musafili
authors: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Akademiska Sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden.
authors: Pauline
authors: P
authors: Binder-Finnema
authors: School of Education, Health and Social Studies, Dalarna University, SE-791 88, Falun, Sweden.
authors: Marie
authors: M
authors: Klingberg-Allvin
authors: Department of Obstetrics & Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Rwanda, P.O.Box 3286, Kigali, Rwanda.|Department of Clinical Research, University Teaching Hospital of Kigali, BP 655, Kigali, Rwanda.
authors: Stephen
authors: S
authors: Rulisa
authors: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Akademiska Sjukhuset, Uppsala University, SE-751 85, Uppsala, Sweden.
authors: Birgitta
authors: B
authors: Essén
mesh_terms: D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D019458:Insurance Coverage; D008427:Maternal Health Services / Q000191:economics; D000067491:Near Miss, Healthcare; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000523:psychology*; D036301:Qualitative Research; D012432:Rwanda; D055815:Young Adult