Healthcare System Barriers in the Management of High-Risk Pregnancy: A Mixed Methods Study from District Jhajjar, Haryana, India

Abstract

Background: High-risk pregnancies (HRPs) contribute substantially to maternal morbidity and mortality in India. Effective management is critical for early identification, monitoring, and timely referral. However, systemic constraints may limit optimal service delivery. This study assessed healthcare system barriers in the management of HRPs in a rural district of Haryana using a mixed methods approach.

Methods: A convergent mixed methods study was conducted in District Jhajjar, Haryana. Quantitative assessment of 10 subcentres was undertaken using a structured facility checklist to evaluate infrastructure, availability of essential equipment, and provision of antenatal services. Concurrently, in-depth interviews were conducted with 12 frontline healthcare providers (4 Lady Medical Officers, 4 Auxiliary Nurse Midwives, and 4 Accredited Social Health Activists) to explore perceived barriers in HRP identification, referral, and service delivery. Quantitative data were analyzed descriptively. Qualitative data were transcribed verbatim and analyzed using inductive thematic analysis. Findings were integrated during interpretation.

Results: While most subcentres had basic utilities, 40% reported inadequate space, 30% lacked examination tables, and 30% did not conduct blood glucose testing during antenatal visits. Equipment gaps and service limitations were noted in several facilities. Thematic analysis revealed challenges in client engagement and referral compliance, infrastructural and logistical constraints, barriers to timely antenatal care, limited community support, and gaps in referral coordination. Providers emphasized that infrastructural limitations and transport delays hindered effective management of HRPs.

Conclusion: Healthcare system constraints continue to impede optimal management of high-risk pregnancies in rural Haryana. Strengthening facility readiness, ensuring essential diagnostic services, and improving referral coordination are necessary to enhance maternal health outcomes.