Introduction
Effective interventions are needed to meet the Sustainable Development Goals and The Every Newborn Action Plan for newborn mortality and stillbirth reduction (≤12 per 1000 births by 2030), particularly in middle- and low-income countries where the burden is greatest.(1) A range of simple to sophisticated methods to detect problems during pregnancy and birth have been developed.(2) Fetal movements (FMs) are the oldest and most basic form of fetal monitoring and can be done by the mother herself without any resources. The complexity of movements requires fetal neuromuscular development and a normal metabolic state of the central nervous system.(3) Women, on average, start to feel movements between 18-20 weeks of gestation and will quickly be aware of a regular, personal pattern of movements of their child.(4, 5) The amount of daily movements increase during the third semester and reach a plateau in the last six weeks of pregnancy. Direct experimental evidence in fetal lambs (6) and observational evidence in human fetuses (7) indicate that reduced body movements and breathing movements is an appropriate physiological response to conserve energy during hypoxia or acidaemia. These alterations in movements have been shown to precede a stillbirth before any other recordable fetal changes, and are registered as early as 48 hours to two weeks before the confirmation of fetal death.(8-12) Newborn babies with hypoxia are typically limp and immobile, until the physiological transition to continuous respiration.(13) This suggests that early detection and management of reduced FMs may prevent adverse perinatal outcomes. (8-11) However there is insufficient evidence from randomized trials to guide clinical practice. (14-16) Limitations of these randomized trials is that reporting decreased fetal movements is an intuitive action which cannot be eliminated from the control group and the fact that all trials have been conducted in high-income countries.(17) There is a dearth of evidence on women’s and healthcare provider’s awareness, knowledge, subsequent practices and use of FMs as a strategy to prevent stillbirths in low-resource settings. Therefore, this study aimed to explore knowledge and perspectives on maternal perception of FMs and practices on perceived abnormal fetal movements among mothers and healthcare providers in a busy maternity unit in a low-income country.