Factors affecting the utilisation of antenatal care among pregnant women

CHAPTER ONE

GENERAL INTRODUCTION

1.0 Introduction

Antenatal care is a type of preventive health care with the goal of providing regular check-ups that allow doctor or midwives/nurse to treat and prevent potential health problems throughout the course of pregnancy while promoting healthy life style that benefits both mother child (Isatou et al, 2012). According to WHO (2015) around eight hundred and thirty women died every day from pregnancy related problems and child birth because they didn’t attend ANC. Almost all of these death occurs in developing countries.

One of the aims of the Millennium Development Goal (MDG) is to reduce mother and child mortality and morbidity. Several deaths are mainly due to hemorrhage, eclampsia, infections, abortion, complication and obstructed labor. Another issue compounding maternal morbidity and mortality include lack of knowledge on the importance of Antenatal Care (ANC) by pregnant women. A good antenatal care is an important element in reducing maternal morbidity and mortality and thus providing pregnant women with a broad range of health promotion activities(Jallow et al, 2010).

Antenatal care is a term use to describe the activities that are carried out during pregnancy (smith, 2015).  In 1994, William Hotn carried out a study on antenatal care to reduce fetal mortality by 40%. American women began antenatal clinic during the first trimesterANC activities were based on the traditional European model which was developing in the early 1900s. In Western Europe North America and many other countries ANC visits went up to 12-16 visits in health care services for women with normal pregnancy (Bui et al, 2011).

Analytical review of the recent world health statistics shows that ANC coverage between 2006 and 2013 was directly correlated with maternal mortality ratio and this indicates that countries with low ANC coverage are countries with high maternal mortality rate. ANC coverage in united Arab emirate was 100% with 8 per 100.000 and Ukraine had 99%. In sub-Saharan Africa, Ghana had ANC coverage of 96% and maternal mortality rate of 980/100.000 (Kobinisky, 2013). ANC coverage in Cameroon in 2007 stood at 82% with 60% of pregnant women having four or morevisits. Maternal mortality ratio has dropped by 47% worldwide during the past 9 years (WHO, 2010).

The WHO recommend minimum of four visits for women with normal pregnancy that is one visit in each 1^st and 2^nd trimester and other visits in the 3^rd trimester. Antenatal care encompasses pregnancy related services provided between conception and the onset of labor with the aim of improving pregnancy out come and the health of the mother and child (WHO, 2013).

According to the theoretical statement of Philuip (2013) despite the availability of services, accessing health care remains a problem in many developing countries, perinatal care has the potential to improve perinatal outcome and decrease health dispenses. Yet many women struggle with access to care.

1.1 Background

Antenatal care is the care given to pregnant women in order to have a safe pregnancy and a healthy baby. Antenatal care is an important determinant of high maternal mortality rate and one of the basic components of maternal care on which the life of mothers and babies depend.

Thus, Antenatal care is a key strategy to improve maternal and infant health, (Mary et al, 2016). Different studies have found that inappropriate antenatal care has been associated with adverse pregnancy outcomes, (Ducic et al, 2012).

Recently the technical working group of World Health Organization has recommended a minimum level of care to be eight visits throughout the pregnancy to reduce the maternal morbidity and mortality. Several studies conducted in different countries on demographic and socio-cultural factors influencing use of maternal health care services, have shown that factors like maternal age, number of living children, education, place of residence, occupation, religion and ethnicity are significantly associated with use of antenatal care, (Carolan et al, 2015).

A study done in Bangladesh showed that the probability for use of ANC in women in the highest wealth index group is higher despite their difference in place of residence and educational level, women were found to have a higher level of use of ANC. This depicts that household wealth is a very strong determinant of health service utilization, (Ducic, 2010)

Approximately 536,000 maternal deaths occur annually, of which over 95% occur in sub-Saharan Africa and Asia. Amongst WHO countries, globally 30% of women between the age group of 15-40 years do not have ANC, 46% of those who did not have ANC are in South Asia while 34% are in sub-Saharan Africa. This low use of services leads to death and disability due to untreated hypertensive disorders or due to mal- or sub-nutrition like iron deficiency anemia.  Cameroon being one of the WHO country is not left,(Léonar et al, 2012),

The lower rate of ANC utilization and delivery assistance services has been established as contributing factors for higher rate of maternal mortality. In disadvantaged regions of the world like Ethiopia where such service is poorly developed, maternal mortality remained to be a big challenge in public health. To address these issues, different stakeholders at international, national, and regional levels have been implementing different strategies. The MDG has been one of the internationally coordinated biggest initiatives, (Cassar, 2012).

But countries having poor infrastructures, low ANC utilization, and assistance delivery rates have been progressing poorly, Cameroon could be an example. Use of maternal health services has shown almost no change in the country in the five years from 2015 to 2019 and maternal mortality and morbidity remains one of the highest in the world,(Fourn et al,2010).

The findings of various factors associated with utilization of antenatal care have not been synthesized collectively. Therefore, there was a need to carry out a literature review to synthesize findings collectively regarding the factors affecting the utilization of antenatal care.

 Hence the objective of this study is to appraise the factors affecting antenatal care utilization among pregnant women. The findings of this literature review could help in planning and developing strategies for utilization of antenatal care ANC among pregnant women. (WHO, 2013).

1.2 Problem statement

The importance of ANC cannot be underestimated because it would detect abnormalities, support, health guidance and offer guidance that will halt preventable illnesses in mother and child. The WHO recommends a minimum of four visits per ANC for prenatal women but according to figures between 2010 and 2018, only 53% of pregnant women worldwide attend the recommended four visits.

According to WHO, 2013 over half a million women die each year over the world due to pregnancy and birth-related complications. Official results from a demographic health survey in 2011 indicates that 15% of pregnant women do not go for antenatal consultations and statistics form the ministry of public health tells us that out of every 100,000l live births the country loses 782 women.

The maternal and infant mortality rate can be described as unacceptable. During an internship practice it was realized that many pregnant women do not come for ANC. This prompted the researcher to find out the factors affecting or influencing the utilization of antenatal care amongst pregnant women in the Regional Hospital Buea. The findings from this study will help in deriving strategies to encourage the utilization of ANC by pregnant women.

1.3 Goal of the study

The goal of this research is to find out the factors affecting the utilization of ANC by pregnant women at the Regional Hospital Buea so that they will know the importance of regular ANC. The research is based on creating awareness and solving barriers that prevent women from attending regular ANC regularly.

1.4 Research questions

• What are the factors that motivate women to utilize ANC services in Buea Regional Hospital?
• What are the factors that deter women from attending ANC in Buea Regional Hospital?
• How can they be encouraged to utilize ANC services?

1.5 Research objectives

1.5.1 General objective

To determine the factors affecting the utilization of ANC by pregnant women at the Buea Regional Hospital.

1.5.2 Specific objectives

1. To assess the knowledge of women on the importance of ANC
2. To find factor that influence the utilization of ANC