Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study

Kwesiga, Doris; Tawiah, Charlotte; Imam, Md Ali; Tesega, Adane Kebede; Nareeba, Tryphena; Enuameh, Yeetey A K; Biks, Gashaw A.; Manu, Grace; Beedle, Alexandra; Delwar, Nafisa; Fisker, Ane B.; Waiswa, Peter; Lawn, Joy E.; Blencowe, Hannah

doi:10.1186/s12963-020-00228-x

Population Health Metrics

Table 1 Overview of themes: barriers to reporting of pregnancy and adverse pregnancy outcomes (APOs)

From: Barriers and enablers to reporting pregnancy and adverse pregnancy outcomes in population-based surveys: EN-INDEPTH study

Major theme	Sub-theme	Barriers to reporting of pregnancy	Barriers to reporting of adverse outcomes
Socio-cultural and spiritual beliefs	Stigma	Unplanned pregnancy, fear of judgement	Blame for women for these APOs; fear of judgement and stigma from the community
	Religion	Religion discourages pregnancy before marriage	Fatalism about APOs or seen as punishment
	Witchcraft and spiritual beliefs	People with ill intentions will harm the baby; evil spirits attracted by disclosure	Miscarriage and stillbirth caused by spiritual harm, or punishment; talking about it may cause a reoccurrence of APO
	Variation in recognition of the baby’s value		Baby not considered human; value attached to a baby influences reaction to death
	Burial and mourning practices		Often different for APOs, especially miscarriages and stillbirths; secretive burials
	Descriptions/names of APOS		Names with negative meanings; same names used to mean different APOs
	Trust/privacy	Lack of trust, unsure of privacy and confidentiality of their information
	Gender & patriarchy	Men who do not want their wives to be interviewed; more barriers for interviewer of a particular sex
Woman-specific	Age	Adolescent girls: secretive, scared and shy
Woman-specific	Individual response to pregnancy	Woman unsure about pregnancy and considering if to terminate the pregnancy
Psycho-social impact of APOs	Negative psychological and emotional impact		APOs cause grief and sadness. Talking about them resurrects bad memories
Survey interview tools and processes	Specific to these outcomes	Questions on APOs considered irrelevant, purpose and benefits not clear to women Questions are intrusive on a sensitive topic
Survey interview tools and processes	General	Interviewer skills, strategies and knowledge Long interview tools with apparently repetitive questions Physical distance challenges in locating respondents High workload for interviewers Inconvenient time of interviews Multiple call-backs to a household to locate right respondent

Note: Enablers to reporting of pregnancy and adverse pregnancy outcomes were generally the converse of the barriers. Specific enablers mentioned focused on the ‘Survey interview tools and processes’ theme and included enabling factors around the interview process, interviewer skills and strategies and the respondents understanding of and perceived benefits from the interview

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ISSN: 1478-7954

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