36 research outputs found
Why do women not use antenatal services in low and middle income countries? A metasynthesis of qualitative studies
Background:
Almost 50% of women in low & middle income countries (LMIC’s) don’t receive adequate antenatal care. Women’s views can offer important insights into this problem. Qualitative studies exploring inadequate use of antenatal services have been undertaken in a range of countries, but the findings are not easily transferable. We aimed to inform the development of future antenatal care programmes through a synthesis of findings in all relevant qualitative studies.
Methods and Findings:
Using a pre-determined search strategy, we identified robust qualitative studies reporting on the views and experiences of women in LMIC’s who received inadequate antenatal care. We used meta-ethnographic techniques to generate themes and a line of argument synthesis. We derived policy relevant hypotheses from the findings.
We included 21 papers representing the views of more than 1230 women from 15 countries. Three key themes were identified: ‘Pregnancy as socially risky and physiologically healthy’; ‘Resource use and survival in conditions of extreme poverty’and ‘Not getting it right first time’. The line of argument synthesis describes a dissonance between programme design and cultural contexts that may restrict access and discourage return visits. We hypothesize that centralized, risk-focused antenatal care programmes may be at odds with the resources, beliefs and experiences of pregnant women who underuse antenatal services.
Conclusions:
Our findings suggest that there may be a mis-alignment between current antenatal provision and the social and cultural context of some women in LMIC’s. Antenatal care provision that is theoretically and contextually at odds with local contextual beliefs and experiences are likely to be underused, especially when attendance generates increased personal risks of lost family resource or physical danger during travel; when the promised care is not delivered due to resource constraints; and when women experience covert or overt abuse in care settings
Recruitment of Subjects for Clinical Trials after Informed Consent: Does Gender and Educational Status Make a Difference?
CONTEXT: Researchers and investigators have argued that getting fully
informed written consent may not be possible in the developing
countries where illiteracy is widespread. AIMS: To determine the
percentage of patients who agree to participate in a trial after
receiving either complete or partial information regarding a trial and
to find out whether there were gender or educational status-related
differences. To assess reasons for consenting or refusing and their
depth of understanding of informed consent. SETTINGS AND DESIGN: A
simulated clinical trial in two tertiary health care facilities on
in-patients. METHODS AND MATERIAL: An informed consent form for a mock
clinical trial of a drug was prepared. The detailed / partial procedure
was explained to a purposive sample of selected in-patients and their
consent was asked for. Patients were asked to free list the reasons for
giving or withholding consent. Their depth of understanding was
assessed using a questionnaire. Chi-square test was used for
statistical analyses. RESULTS: The percentages of those consenting
after full disclosure 29/102 (30%) and after partial disclosure 15/50
(30%) were the same. There was a significant (p=0.043) gender
difference with a lesser percentage of females (30%) consenting to
participation in a trial. Educational status did not alter this
percentage. Most patients withheld consent because they did not want to
give blood or take a new drug. Understanding of informed consent was
poor in those who consented. CONCLUSIONS: The fact that only one-third
of subjects are likely to give consent to participate in a trial needs
to be considered while planning clinical trials with a large sample
size. Gender but not educational status influences the number of
subjects consenting for a study. Poor understanding of the elements of
informed consent in patients necessitates evolving better methods of
implementing consent procedures in India. (J Postgrad Med
2003;49:110-113