Table 3.

Linkages between the third order themes, triggers, drivers and consequences

Third order themes	Immediate triggers	Underlying drivers	Consequences of event
Physical abuse	Desire to save lives	Normalization Frustration of health providers associated with broader health system constraint/environment Gender inequalities and inadequate understanding of individual rights	Deter future facility delivery
Verbal abuse	Negative patient outcomes triggering some form of reprimand Desire to save lives	Normalization Complex legal redress mechanisms Frustration of health providers due to health system constraints- weak governance structures and accountability	Deter future facility delivery
Stigma and discrimination	Multiparous women Geographical location of women- poor neighborhoods/dress code Age –young teenagers Surnames HIV status	Broader community and societal/social economic challenges Tribalism Lack of knowledge or of patients’ rights	By passing nearest facilities leading to potential morbidities and mortalities associated with delays during self-referrals Deter future facility use
Failure to meet professional standards of care	Multiparous women Geographical location of women- poor neighborhoods/dress code Age –young teenagers	Health system drivers- Human resource challenges, weak legal and policy implementation Broader social cultural norms	By passing near facilities leading to potential morbidities and mortalities associated with delays during self-referrals Deter future facility use
Poor rapport between women and health providers	Geographical location of women-poor neighborhoods/dress code	Health system drivers- Human resource challenges Tribalism	By passing nearest facilities leading to morbidities and mortality associated with delays during self-referrals Deter future facility use