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

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. 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. 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. 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. Pregnancy is a momentous and life-changing experience for a woman. Although pregnancy is a natural process, certain health conditions like low haemoglobin level, high blood pressure, etc., can lead to a significant risk for the mother, fetus, or both. Such pregnancies are termed high-risk pregnancies, and it is a major health hazard globally. Women with high-risk pregnancies require heightened attention and care; early identification may lead to better management of such pregnancies. The present study aims to identify key challenges and facilitators in managing these pregnancies from the perspective of pregnant women. Pregnant women were interviewed and asked about their understanding of the topic and the prenatal, intranatal, and postnatal care they received. It was found that illiteracy, poor healthcare access, geographic isolation, financial constraints, and cultural norms are major barriers to the identification and management of high-risk pregnancies. Community engagement and participation, support and participation of healthcare providers, and support from government schemes and policies are major facilitators of such pregnancies.