Barriers and facilitators for high-risk pregnancy care: a qualitative study on the perspective of pregnant women of rural Rajasthan.

BACKGROUND

High-risk pregnancies, which pose serious risks to the mother and fetus, remain a major global challenge, and the burden is intensified in India due to socio-economic disparities and inadequate healthcare infrastructure. Despite multiple government programs and social support initiatives, substantial gaps persist in identifying and managing high-risk pregnancies. This qualitative study examines the identification and management of high-risk pregnancies in Rajasthan by exploring the key challenges and facilitators from the perspective of pregnant women. It provides one of the first rural Rajasthan–based accounts that simultaneously considers individual, social, and institutional determinants of high-risk pregnancy care.

METHODS

The present qualitative study was conducted in three Primary Health Centres (PHCs) in the Nagaur District of Rajasthan, India. A total of 15 in-depth interviews (IDIs) and 2 focus group discussions (FGDs) were conducted with pregnant women reporting to the antenatal care (ANC) clinic. Purposive sampling was used, and interviews continued until saturation; data collection was carried out between April and May 2024.

RESULTS

Barriers identified included illiteracy, limited access to healthcare, geographic isolation, financial constraints, and cultural norms. Limited awareness among women and healthcare providers, along with inadequate resources and training, led to delayed care and ineffective management of high-risk pregnancies. Facilitators included increasing institutional deliveries, community engagement and participation, supportive healthcare providers, and assistance from government schemes and policies.

CONCLUSION

The study highlights the need to strengthen infrastructure and adopt a patient-centred care model to improve maternal and neonatal outcomes in underserved communities. Key recommendations include enhancing women’s education and awareness, expanding access through mobile health clinics and telemedicine, addressing workforce shortages through better working conditions and training, and establishing effective grievance-redressal mechanisms to build trust in the healthcare system.