A Systems Dynamics Approach to Understanding the Determinants of Antenatal Care Utilization in Low-and Middle-Income Countries

Agnes Rwashana Semwanga,Hasifah Kasujja Namatovu

doi:10.4018/ijsda.2020100106

Abstract

There has been low adherence of antenatal care utilization (ANC) in low and middle-income countries (LMIC) despite its associated negative outcome on women and their unborn babies. Although several studies have examined ANC, the majority focus on isolated aspects and do not explore the holistic approach to understand its dynamics. The system dynamics approach provides a deeper understanding of the phenomenon by examining the underlying factors, causes, effects, feedback, and delays. This study aimed at understanding factors that influence ANC utilization using the system's dynamics approach. An interpretive systematic review to establish multifaceted and context-specific processes was done between May and November 2019. Data from 24 articles were synthesized and used to build causal loop diagrams, which were validated through focus group discussions and interviews with stakeholders. Results revealed human resource numbers and welfare, awareness campaigns, peer support groups, and community-based engagement as key leverage points towards ANC improvement.

Highlights

Unlike the developed world, maternal mortality is one of the greatest health and development concerns in the developing world (Paxton & Wardlaw, 2011)
The variables associated with antenatal care utilization (ANC) utilization were categorized as demand factors and supply factors (Table 3)
What is peculiar about the findings is the fact that more than half of the determinants are common across the regions, implying that common interventions can be applied in different regions

Summary

Introduction

Maternal mortality is one of the greatest health and development concerns in the developing world (Paxton & Wardlaw, 2011). About 830 women die every day from pregnancy and childbirth-related complications and approximately 303,000 women died worldwide in 2015 during and following pregnancy and childbirth (WHO, 2018). Antenatal care (ANC) reduces maternal and perinatal mortality and morbidity through detection and treatment of pregnancy-related complications, and the identification of women and girls at increased risk of developing complications during labor and delivery, ensuring referral to an appropriate level of care (Kuhnt and Vollmer, 2017; WHO, 2016). ANC is the care given by skilled healthcare providers to pregnant women and adolescent girls in order to ensure the best health conditions for both mother and baby during pregnancy (WHO, 2016). ANC includes risk identification; prevention and management of pregnancy-related or concurrent diseases; and health education and promotion (WHO, 2016). WHO envisions a world where “every pregnant woman and newborn receives quality care throughout the pregnancy, childbirth and postnatal period” (Tuncalp et al 2015)

Objectives

Results

Conclusion