Abstract
BackgroundAccess to adequate antenatal care (ANC) is critical in ensuring a good maternal health and in preventing maternal and neonatal morbidity and mortality. South Sudan has one of the world’s poorest health indicators due to a fragile health system and a combination of socio-cultural, economic, and political factors. This study was conducted to identify barriers to utilisation of ANC services in Rumbek North County.MethodsUsing a qualitative design, data were collected through 14 focus group discussions with 169 women and 45 men and 12 key informant interviews with community leaders, staff working in health facilities, and the staff of the County Health Department. Data were analysed using inductive content analysis.ResultsThe perceived barriers to ANC utilisation were categorised as follows: 1) Issues related to access to health facilities and lack of resources. These included long distance to health facilities, lack of means of transportation to the health facilities, floods and poor roads, and demand for payment for health care at some health facilities; 2) The influence of the socio-cultural context and conflict including heavy burden of domestic chores, the negative influence of husbands who were reluctant to allow their wives to attend ANC, and insecurity; 3) Perceptions about pregnancy including misperceptions about the benefits of ANC and low perceived risk of pregnancy-related complications; and 4) Perceptions about the quality of care and the efficacy of medical treatment.ConclusionsThis study identified a myriad of factors deeply entrenched in the society, which prevent women from utilising ANC services. It also elicits broad aspects of interconnectedness among the barriers. To ensure effectiveness, strategies to improve utilisation of ANC in the study area and in similar contexts need to take into account the barriers identified by this study.
Highlights
Access to adequate antenatal care (ANC) is critical in ensuring a good maternal health and in preventing maternal and neonatal morbidity and mortality
Strategies to improve utilisation of clinics for care during pregnancy in Rumbek North should address the issues identified in this study
Each one of the Primary health care unit (PHCU) was run by one community health worker (CHW), one traditional birth attendant (TBA), and one drug dispenser
Summary
Access to adequate antenatal care (ANC) is critical in ensuring a good maternal health and in preventing maternal and neonatal morbidity and mortality. South Sudan has one of the world’s poorest health indicators due to a fragile health system and a combination of socio-cultural, economic, and political factors. Access to adequate antenatal care (ANC) is critical in ensuring a good maternal health and in preventing neonatal morbidity and mortality [2]. South Sudan, the world’s youngest nation, is plagued by a myriad of challenges including a fragile health system, which has been aggravated by decades of armed conflict, resulting in a poor health status of the population. Only one published study, based on data from the 2010 SHHS, has attempted to explore the factors associated with non-use of ANC [5]. More information is needed for evidence-based planning of ANC service delivery in this context
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