Risk perceptions among high-risk pregnant women in an aspirational district of India: a qualitative study


  • Rinku Borah Department of Community Medicine, Dhubri Medical College, Assam, India https://orcid.org/0000-0001-9525-8941
  • Parimita Roychoudhury Department of Community Medicine, Dhubri Medical College, Assam, India
  • Sabrina Yasmin Department of Community Medicine, Dhubri Medical College, Assam, India




High risk, Risk acceptance, Risk denial, Risk perception


Background: Attitude and behavior towards health seeking decisions are affected by one’s risk perceptions. This formed a key component in many health behavior-change theories and is responsible for reduction of perinatal mortality. A woman’s perception of risk affects her decisions about seeking obstetric care. This study explored the perceptions of high-risk pregnancy among women with high risk factors.

Methods: A qualitative study was conducted in an aspirational district of India. Participants included pregnant women in third trimester with high risk factors. In-depth interviews were conducted with 34 participants using semi-structured interview schedule.

Results: Three main themes emerged in this study: (i) knowledge of risk (ii) attitude towards risk (iii) adoption behavior. The study found out women’s lack of understanding on high-risk conditions during pregnancy, especially among younger age group. Majority denied the risk factor and normalized delivery on one’s faith.

Conclusions: The findings of this study provide a glimpse into how women perceived risk and the reasons that lead them to deny the risks. Women must understand their risk in the same way as their healthcare providers. If an event is not appraised as severe, there will be no change in behavioral intentions inspite of all the efforts put by the government for reducing perinatal mortality.



Fischhoff B, Bostrom A, Quadrel MJ. Risk perception and communication. Annu Rev Public Health. 1993;14(1):183-203.

Blackburn ST. Assessment of risk: perinatal, family and environmental perspectives. Phys Occupat Ther Pediatr. 1986;6(3-4):105-20.

High risk pregnancy. National Health Portal of India. Available from: https://www.nhm.gov.in/New_Update-2022-23/MH/GUIDELINES-%20MH/Guidance_Note-Extended_PMSMA_for_tracking_HRPs.pdf#:~:text=As%20per%20literature%2C%20about%2020-30%25pregnancies%20belong%20to%20high,PMSMA%20reporting%20platform%2C%20varying%20from%20State%20to%20State. Accessed on 1 February 2023.

Lee S. Risk perception in women with high-risk pregnancies. Br J Midwife. 2014;22(1):8-13.

Heaman M, Gupton A, Gregory D. Factors influencing pregnant women’s perceptions of risk. Am J Matern Child Nurs. 2004;29(2):111-6.

World Health Organization. Risk approach for maternal and child health care: a managerial strategy to improve the coverage and quality of maternal and child health: World Health Organization; 1978.

Ferrer RA, Klein WM. Risk perceptions and health behavior. Curr Opin Psychol. 2015;5:85-9.

Carolan M. Towards understanding the concept of risk for pregnant women: some nursing and midwifery implications. J Clin Nurs. 2009;18(5):652-8.

Kowalewski M, Jahn A, Kimatta SS. Why do at-risk mothers fail to reach referral level? Barriers beyond distance and cost. Afr J Reprod Health. 2000;4(1):100-9.

Lee S, Ayers S, Holden D. A metasynthesis of risk perception in women with high-risk pregnancies. Midwifery. 2014;30(4):403-11.

Rogers RW. A protection motivation theory of fear appeals and attitude change. J Psychol. 1975;91(1):93-114.

Dujardin B, Clarysse G, Criel B, De Brouwere V, Wangata N. The strategy of risk approach in antenatal care: evaluation of the referral compliance. Soc Sci Med. 1995;40(4):529-35.

Gupta J, Gupta H. Perceptions of and constraints upon pregnancy-related referrals in rural Rajasthan, India. Health Serv Manage Res. 2000;13(1):6-15.

Sample registration system. Special bulletin on maternal mortality in India 2018-20. Government of India. Available from: https://censusindia.gov.in/census.website/data/SRSMMB. Accessed on 1 February 2023.

Weinstein ND. Unrealistic optimism about susceptibility to health problems: Conclusions from a community-wide sample. J Behav Med. 1987;10(5):481-500.

Edwards A, Elwyn G, Mulley A. Explaining risks: turning numerical data into meaningful pictures. BMJ. 2002;324(7341):827-30.

Jordan RG, Murphy PA. Risk assessment and risk distortion: finding the balance. J Midwife Womens Health. 2009;54(3):191-200.

Gray BA. Hospitalization history and differences in self-rated pregnancy risk. West J Nurs Res. 2006;28(2):216-29

Holten L, de Miranda E. Women s motivations for having unassisted childbirth or high-risk homebirth: An exploration of the literature on ‘birthing outside the system’. Midwifery. 2016;38:55-62.

Patterson K. Experience of risk for pregnant black women. J Perinatol. 1993;13(4):279-84.

Lee S, Ayers S, Holden D. Risk perception of women during high-risk pregnancy: a systematic review. Health Risk Soc. 2012;14(6):511-31.

Heaman M, Gupton A, Gregory D. Factors influencing pregnant women’s perceptions of risk. MCN Am J Matern Child Nurs. 2004;29(2):111-6.

Atkinson SJ, Farias MF. Perceptions of risk during pregnancy amongst urban women in northeast Brazil. Soc Sci Med. 1995;41(11):1577-86.

Harrison MJ, Kushner KE, Benzies K, Rempel G, Kimak C. Women’s satisfaction with their involvement in health care decisions during a high- risk pregnancy. Birth. 2003;30(2):109-15.

Papiernik E, Tafforeau J, Richard A, Pons JC, Keith LG. Perception of risk, choice of maternity site, and socio-economic level of twin mothers. J Perinat Med. 1997;25(2):139-45.

Choudhury N, Ahmed SM. Maternal care practices among the ultra-poor households in rural Bangladesh: a qualitative exploratory study. BMC Pregnancy Childbirth. 2011;11(1):1-8.

Rajbanshi S, Norhayati MN, Nik Hazlina NH. Risk perceptions among high-risk pregnant women in Nepal: a qualitative study. BMC Pregnancy Childbirth. 2021;21:1-8.




How to Cite

Rinku Borah, Roychoudhury, P., & Yasmin, S. (2023). Risk perceptions among high-risk pregnant women in an aspirational district of India: a qualitative study. International Journal Of Community Medicine And Public Health, 10(7), 2479–2485. https://doi.org/10.18203/2394-6040.ijcmph20232040



Original Research Articles