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Socio-technical challenges in accessing antenatal services during pregnancy complications in Ecuador and the opportunities for digital health

Abstract:

Objective: In Latin America, there is an increasing prevalence of pregnancy complications, leading to poor maternal and neonatal outcomes. Although essential antenatal health services are available to diagnose and treat pregnancy-related complications, their uptake is low and results in many Latin American women not receiving adequate antenatal care. This study aimed to understand the challenges experienced by women managing high-risk pregnancies while interacting with antenatal services and the perceived value of digital health in supporting their care practices. Methods: This qualitative case study collected data through eight focus group discussions with 43 pregnant women with complications, and 33 semi-structured interviews with healthcare professionals across different levels of the healthcare infrastructure in public and private hospitals and health subcenters in three Ecuadorian cities. Results: Our findings uncovered a number of material, spatial, technical, organizational, and everyday life constraints that negatively impacted women's access and experiences with antenatal services during pregnancy complications. Unintended consequences were also discovered in the fragmented Ecuadorian healthcare system, including extra data work, duplication of information, incomplete medical records and delayed diagnosis. Another important finding was the necessity for emotional support for healthcare professionals and pregnant women dealing with complications. Healthcare professionals and pregnant women perceived value in digital health that can support women's self-care practices as well as the communication, coordination and information management within and across healthcare institutions to improve antenatal care. Conclusions: This study provides a contextual understanding of the socio-technical challenges and constraints that affect the access and uptake of antenatal services during pregnancy complications in Ecuador. We discuss the potential of digital health to support both women and healthcare professionals’ efforts while caring for pregnancy complications and the need for taking a sociomaterial approach to scope digital health opportunities in antenatal care.