Antenatal health care policy, services and clients in urban Papua New Guinea

Abstract

This article describes the nurse-operated antenatal clinic services in Port Moresby, Papua New Guinea, and reports the findings of a survey of 365 women attending the Port Moresby General Hospital antenatal clinic. Only 9% of the women surveyed attended the clinic in the 1st trimester of their pregnancy, with the majority making their 1st visit toward the end of the 2nd trimester. There was a trend toward later 1st visits with higher parities. 74% of previous deliveries had been in a hospital. Low hemoglobin level (52% under 10 gm%) was the common risk factor noted in the sample. The number of attendees generally decreased with increasing distance between home and hospital. To explore the factors associated with clinic attendance, a subsample of 48 women were interviewed in depth. Clinic attendance was found to be significantly associated with the experience of current or previous obstetrical problems. The need to discover problems, obtain medication, and gain knowledge were reasons cited for clinic attendance. Respondents indicated they selected the hospital clinic because they expected greater expertise or better services. Clinic attendance was in some cases adversely affected by personal embarrassment stemming from questions about marital status from staff. Approximately 75% of women in the sample came from heterogeneous suburban areas that lack the social support systems commonly provided by extended family groupings. It is suggested that nursing interventions, based on comprehensive counseling as well as a caring approach, can play a unique role in the professional support system for obstetric care. It is important for nurses who function in antenatal clinic settings serving clients of diverse ethnicity to be aware of the cultural beliefs and values that influence health care perceptions and practices. Although nurses perform the majority of antenatal care in Papua New Guinea, their knowledge of high risk factors is weak. Use of a specialized antenatal clinic card, as well as continuing education, are recommended to sharpen nurses' assessment skills and facilitate early detection of high risk clients.