Abstract
<title>Abstract</title> <p>Background Maternal mortality in Malawi remains unacceptably high despite continued efforts to improve maternal health outcomes. A functioning obstetric referral system is critical for timely access to emergency obstetric care and reducing preventable maternal and neonatal deaths. This study explored the challenges in the obstetric referral system at the Chitedze and Nathenje Health Centres in Lilongwe District. Methodology: A qualitative descriptive approach was used. Data were collected from 30 participants comprising 15 nurse midwife technicians and registered nurse midwives purposively sampled, and 5 patients and 10 guardians recruited through convenience sampling. Semi-structured interview guides were used during in-depth interviews and focus group discussions; all sessions were audio-recorded. Data analysis followed Braun and Clarke's six-phase thematic framework. Results Six themes emerged: (1) inadequate human resources, (2) shortages of essential equipment and supplies, (3) transportation and logistical challenges, (4) incomplete referral documentation, (5) communication barriers, and (6) patient-related barriers. Conclusion The obstetric referral system in Lilongwe faces multiple systemic and operational constraints that compromise timely access to emergency obstetric care. Addressing these barriers through improved staffing, transport logistics, training, documentation, and structured feedback mechanisms is critical to strengthening referral pathways and improving maternal health outcomes in Malawi.</p>