Abstract
BackgroundAntenatal care (ANC) provided by a trained health care provider is important for monitoring pregnancy thereby reducing potential risks for the mother and child during pregnancy and delivery. The World Health Organization (WHO) recommends at least four ANC visits to all pregnant women. While the proportion of women who attend at least one ANC in low-income countries is high, most pregnant women start their first ANC attendance very late. In Tanzania only 24% of pregnant women start their first ANC attendance before the fourth month of pregnancy. While factors for the utilization of antenatal care in general have been widely studied, there is paucity of studies on the factors affecting timing of the first ANC attendance. This study aimed to understand individual, community, and health system factors that lead to the delay in seeking ANC services among pregnant women in Ilala Municipal in Dar es Salaam region, Tanzania.MethodsA qualitative exploratory study, using in-depth interviews with 20 pregnant women and five health care workers was conducted in three different health facilities in Dar es Salaam Tanzania. Thematic analysis approach was used to analyse the data.ResultsIndividual perceptions of antenatal care, past experience with pregnancy, fear of pregnancy disclosure, and socio-cultural beliefs were the key individual and social factors for late ANC attendance. Shortage of trained health care workers, lack of spouse’s escort and health providers’ disrespect to pregnant women were the main health system barriers to early ANC attendance.ConclusionsThis study concludes that community members should be sensitized about the importance of early ANC attendance. Additionally, while spouse’s escort policy is important for promoting PMTCT, the interpretation of the policy should not solely be left to the health providers. District and regional health officials should provide correct interpretation of this policy.
Highlights
Antenatal care (ANC) provided by a trained health care provider is important for monitoring pregnancy, thereby reducing potential risks for the mother and child during pregnancy and delivery
ANC provides the opportunity to detect and treat complications of pregnancy and to deliver preventive health services such as immunisation against tetanus, prophylactic treatment of malaria and worms, and Human Immunodeficiency Virus (HIV) testing and counselling leading to Prevention of Mother to Child HIV Transmission (PMTCT) [2,3,4]
The World Health Organization (WHO) and the Tanzanian Ministry of Health’s ANC guidelines recommend at least four ANC visits for uncomplicated pregnancies with the first visit starting before 12 weeks of gestation [3, 10]
Summary
Antenatal care (ANC) provided by a trained health care provider is important for monitoring pregnancy thereby reducing potential risks for the mother and child during pregnancy and delivery. The World Health Organization (WHO) recommends at least four ANC visits to all pregnant women. In Tanzania only 24% of pregnant women start their first ANC attendance before the fourth month of pregnancy. 300,000 women die each year due to pregnancy related deaths and over 99% of these deaths take place in low income countries and most could have been prevented [1].While the ANC provides the opportunity to detect and treat complications of pregnancy and to deliver preventive health services such as immunisation against tetanus, prophylactic treatment of malaria and worms, and HIV testing and counselling leading to Prevention of Mother to Child HIV Transmission (PMTCT) [2,3,4]. A comparative analysis of the use of maternal health services in subSaharan Africa showed that adolescent mothers initiated ANC attendance even later than adult mothers [11]
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