Table 2.

Positions on maternal–fetal prioritization and accompanying rationale

Position on maternal–fetal priority	Rationale offered	Example quotes
Prioritize woman over pregnancy	She can have another pregnancy/have another child but we can’t get another “her”	“I think the woman’s health should be a priority because she stands to get another pregnancy, so if she loses the one pregnancy she’s carrying or if she gets problems developing [the one] that she’s carrying, she’s still able to get another pregnancy. But, when we have a baby who can’t take care of themselves, the risks in the mother leads her to death, then we are enveloped in the hopeless situation of trying to raise this baby.” Participant 691; healthcare worker, African region “We know that if the mother loses the pregnancy, there is an opportunity to have another baby, but if we lose both the mother and the baby, that is a loss, so usually that is why we say that the mother is the priority.” Participant 992; healthcare worker, African region “As an obstetrician, I cannot delink the two…..as I take care of the health of the mother, the health of the baby is also important, but situations arise where [a] decision can be made in the interest of the health of the mother, but those are specific situations…..when you now know that is the only option you have, then you may make a decision in the interest of the mother that the mother will live for another day to have another baby. But those are really specific situations and cannot be generalized.” Participant 527; healthcare worker/researcher/ethicist, African region
Prioritize woman as patient	She’s the “living” patient	“A woman’s health takes priority. I mean you’re obviously going to consider both, but…….I mean she’s your patient at the outset. She’s the living object of your intervention until the baby’s born.” Participant 586; healthcare worker/researcher, region of the Americas “I think the mother’s health should be the priority, because we’re trying to protect the unborn baby not knowing whether it will be born alive or not…so I think the health of the mother should be the first priority in this case.” Participant 995; researcher, African region “[M]y experience from [country in sub-Saharan Africa] is that the fetus is not viewed as prominently as it is in [Western country], or it doesn’t seem to have as much importance…..because in countries like [country in sub-Sarahan Africa] so many infants die, that it’s much more accepted there than it is [in Western country], and I’m not saying that’s a good thing. But there’s also a greater tendency among obstetricians to give medications that we might not give in [Western country], knowing that there’s a risk to the fetus, because they don’t have other options. And so there is less attention paid to teratogenicity in countries like [country in sub-Saharan Africa].” Participant 980; healthcare worker, region of the Americas
Prioritize avoiding infant harm	Infant priority with serious risk of harm	“If we know that the risk to the infant is going to be severe, I think that absolutely matters. And if it’s [an] 80% chance that something’s going to happen to the infant, then there’s really no point rolling out that option, treatment or prevention.” Participant 309; healthcare worker/researcher/policy developer, European region
Mother first, because infant survival depends on her	Infant survival depends on the mother being alive	“And you know actually, the survival of children to a large extent is dependent on the survival of the mother, especially in our part of the world. And when you lose the mother, chances of losing the baby are also very high.” Participant 202; healthcare worker/researcher/ethicist, African region “….the ideal is to have a healthy mother in the future who can participate as much as possible in caring and raising the unborn child.” Participant 741; healthcare worker/researcher, region of the Americas “I would always go for the mother, protecting the life of the mother over the child, because of what we know and what evidence has shown about the risks to a child if the mother is unwell or the mother dies, then the child is at a higher risk, and especially in developing countries, so I would consider the health of the mother first and then the one of the infant.” Participant 373; healthcare worker, African region
Mother first, because family and community depend on her	She’s the mother of other children - think about her in terms of larger impact on community/family	“I think the health of the woman is absolutely paramount…. as much as there is concern regarding fetal exposure and fetal health, if we’re causing ill health to the woman, however small or big, I think that is something that really needs to be put into the balance, simply because she may be the mother of other children who need her, and she is a big contributor to the community and not only to her own family, and so it is absolutely paramount that the women’s health and women’s position be kept important in any decision, whether it’s research or in a clinical setting.” Participant 309; healthcare worker/researcher/policy developer, European region “If there is a definite benefit to the mother, then that is a treatment one needs to look at very favorably, because in the end, if the mother survives or if you are able to get out of danger, then not only is she able to look after any other children she has, but she can also get others. So, I mean, the benefits to the mother is the final consideration, and a very important one.” Participant 202; healthcare worker/researcher/ethicist, African region
Holistic	Healthy mom = healthy baby (in terms of treating an illness that might adversely affect the pregnancy)	“I feel like ultimately, even if I were to only think about the infant, it’s in the infant’s best interest to have a healthy mom. So I would say prioritize the maternal health because in fact a side effect of that is infant health.” Participant 716; healthcare worker, region of the Americas “I guess I’m always gonna land on what you would consider the side of the mother. But to me, the mother and the baby are sort of inseparable units, but if you’re treating the mother, it’s gonna benefit the baby in general.” Participant 796; healthcare worker, region of the Americas “[P]ersonally, I think [the health of] both is important and the mother’s health is critically important in order for ensuring that her infant reaches term and is delivered safely, so I don’t think her health should be excluded from the equation. But similarly, there should be a priority based on delivering a healthy infant and ensuring that there are no harms to that child because any harms to that child are likely to be life long and likely to be the responsibility of that women and her family and therefore, it’s important to bear that in mind as well.” Participant 131; researcher, African region