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