Abstract
Antenatal care services for pregnant women improve maternal and child health outcomes. It is recognized that antenatal care services are underutilized in developing countries. The objective of the study was to identify the determinants of low utilization of antenatal care services during the first trimester of pregnancy in southern Benin rural setting. The cross-sectional and analytical study included 301 pregnant women, 29 husbands and 21 health workers in Athieme municipality (southern Benin rural setting) and was conducted from 14 April to 14 July 2014. Data on sociodemographic and antenatal services characteristics were collected using questionnaire, semi-structured interviews and focus groups. Determinants of low utilization of antenatal care services were identified using logistic regression model. Among 301 pregnant women, only 24.6% utilized antenatal care services during the first trimester of the pregnancy. Five independent determinants of low utilization of antenatal care services were identified: low education level of pregnant women, OR= 3.3 [95%CI= (1.534:7.071)]; wrong knowledge of the required period for the first attendance to antenatal care service during pregnancy, OR=5.131 [95%CI= (1.972:13.353)]; adequate knowledge of the benefits of the antenatal care service, OR=4.031 [95%CI= (1.401:11.594)]; participation in the behavior change communication sessions, OR=0.059 [95%CI= (0.028:0.125)]; adequate patient-welcome in antenatal care services, OR= 0.162 [95%CI= (0.051:0.513)]. Sociocultural reasons were also mentioned. Pregnant women underutilize free antenatal care services in Athieme municipality. Effective interventions taking into account the identified determinants may contribute to improve the utilization of antenatal services in southern Benin rural setting.
Highlights
Antenatal care (ANC) is one of the four pillars of the Initiative for Safe Motherhood [1]
There is currently little data available at the national level, on obstacles and barriers to the utilization of ANC services by pregnant women during the first trimester of pregnancy. This study addresses this problem with the aim to identify the determinants of low utilization of ANC services in the first trimester of pregnancy in pregnant women in a southern Benin rural setting in 2014
The demographic and socio-cultural factors related to pregnancy, socio-cultural factors linked to pregnancy, factors related to accessibility to health services and their characteristics explain the low utilization of ANC in the first trimester of pregnancy and are inter-related
Summary
Antenatal care (ANC) is one of the four pillars of the Initiative for Safe Motherhood [1]. The World Health Organization (WHO) recommends that pregnant women in developing countries initiate early prenatal care before the end of the 4th month of pregnancy [4]. An analysis of Demographic and Health Surveys in 45 developing countries showed that women in sub-Saharan Africa utilized prenatal care much later than women in other regions [5]. In Benin, less than one out of two women (48%) completed her first prenatal visit before the fourth month of pregnancy [6]. In 28% of cases, pregnant women waited 4-5 months before attending ANC provide by skilled health workers [7]. The three delay model especially affecting antenatal attendance and reference includes the mothers’ failure to have health
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