Table 3 Themes or categories of interest obtained from the final analytical framework with constituent codes, descriptions of codes, and illustrative quotes

Resource availability

 Ultrasound service availability

Text or phrases related access to the pregnancy dating and Doppler ultrasound services when needed by the women

“When I came back, there was no power, so I returned without going to the scan. Since then, I have been coming and finding no power. I don’t know if I will get a chance of getting scanned today” [R5: FGD 1 with mothers undergoing routine ANC]

“But the way I see, people really like the scan, they like coming here, even today, mothers came for Doppler and we told them we are sorry that our machine went for service” [IDI with Sonographer 2]

“Yes, they told me to go back on 10th of July 2019 but when I went there, they told me that the scan is dead and we came back” [IDI with mother who suffered a neonatal death]

 Doppler exam technicalities

Text describing the Doppler ultrasound examination procedure, including the ease or complexity of performing it and technical limitations of the procedure

“I’m not technical in these things of the scan, but what I have seen when they are doing a Doppler, they take a lot of time…dating is okay but when they are doing Doppler, it takes a lot of time” [IDI with midwife 5]

“Sometimes also, it takes time to get the vessels, as you are getting there, a mother says am tired, you wait and I change, like that. Though others are fast and they don’t take a lot of time” [IDI with Sonographer 1]

 Follow-up of pregnant women

Phrases describing different aspects of the follow-up antenatal care, including follow-up Doppler ultrasound services for pregnant women after initiation of the antenatal care visits

“Some mothers have no contact” [IDI with midwife 5]

“Another thing, may be, is that these mothers complain of distance if you tell them to come back for Doppler” [IDI with midwife 1]

“Those who don’t have phones and their husbands don’t have, we ask for the chairman’s phone who can deliver reminder information and we tell her that we need you on this date” [IDI with midwife 3]

Partner involvement

 Male partner participation

Male partner accompanying his wife or female partner to antenatal care, providing social economic support and ensuring that all recommendations made at the antenatal care are observed to safeguard the wellbeing of the couple and the baby

“Like me, I was with my husband and they told me to go for scan. He also accepted and I came” [R5: FGD 1 with mothers who delivered in the hospital]

“Me, when I heard about the service, I told him and we started from there to come together [R0: FGD 3 with mothers who delivered in the hospital]

“I came with my husband and I told him immediately after the scan about the baby. And when we reached home, we explained to my mother-in-law about all the results they gave us” [R3: FGD 2 with mothers who delivered from home]

“You find you think about going to the hospital, even me I wouldn’t have wished to go to scan late but because you find you are with a man and you don’t agree with each other” [IDI with mothers who suffered a stillbirth]

Safety

 Safety of ultrasound

Potential harm to the mother or fetus resulting from exposure to the ultrasound during fetal life, as perceived by the pregnant women

“I fear the scan, if I don’t have a very serious disease, I can never go for a scan. Because they say that the scan reduces peoples’ years” [R3: FGD 2 with mothers attending routine ANC]

“The truth is, I know very well that when you put your child in the scan, the child won’t be delivered like a clever child. There is a way that electricity affects the child’s brains and he or she becomes dull. So, I said to myself, instead of delivering of a dull child, I would rather not go for the scan” [R1: FGD with mothers who declined an ultrasound examination]

“Most people here associate the scan with reducing years (life expectancy)” [Interview: midwife 5]

“Sometimes they tell you, it reduces our age” [Interview: Sonographer 1]

“Most women in the villages dislike this scan. They think that the scan chops their years” [Interview with midwife 1]

“I had a lot of thoughts but when they educated me about them, I stopped” [Interview with a mother whose baby was diagnosed with a spinal defect]

“I normally hear people say that the scan reduces your years, that if you keep on going to the scan, your years keep on reducing but me I don’t believe in that” [Interview with a mother who had a scan but experienced a stillbirth]

“What they are saying, I think they are lies because when I got out, I have never got any problem” [R4: FGD 1 with mother attending ANC clinic]