“Well, not me, but other women do not register because...”- Barriers to seeking antenatal care in the context of prevention of mother-to-child transmission of HIV among Zimbabwean women: a mixed-methods study

Abstract

BackgroundWhile barriers to uptake of antenatal care (ANC) among pregnant women have been explored, much less is known about how integrating prevention of mother-to-child transmission (PMTCT) programmes within ANC services affects uptake. We explored barriers to uptake of integrated ANC services in a poor Zimbabwean community.MethodsA cross-sectional survey was conducted among post-natal women at Mbare Clinic, Harare, between September 2010 and February 2011. Collected data included participant characteristics and ANC uptake. Logistic regression was conducted to determine factors associated with ANC registration. In-depth interviews were held with the first 21 survey participants who either did not register or registered after twenty-four weeks gestation to explore barriers. Interviews were analysed thematically.ResultsTwo hundred and ninety-nine participants (mean age 26.1 years) were surveyed. They came from ultra-poor households, with mean household income of US$181. Only 229 (76.6%) had registered for ANC, at a mean gestation of 29.5 weeks. In multivariable analysis, household income was positively associated with ANC registration, odds ratio (OR) for a $10-increase in household income 1.02 (95% confidence interval, CI, 1.0–1.04), as was education which interacted with having planned the pregnancy (OR for planned pregnancy with completed ordinary level education 3.27 (95%CI 1.55–6.70). Divorced women were less likely to register than married women, OR 0.20 (95%CI 0.07–0.58). In the qualitative study, barriers to either ANC or PMTCT services limited uptake of integrated services. Women understood the importance of integrated services for PMTCT purposes and theirs and the babies’ health and appeared unable to admit to barriers which they deemed “stupid/irresponsible”, namely fear of HIV testing and disrespectful treatment by nurses. They represented these commonly recurring barriers as challenges that “other women” faced. The major proffered personal barrier was unaffordability of user fees, which was sometimes compounded by unsupportive husbands who were the breadwinners.ConclusionWomen who delayed/did not register were aware of the importance of ANC and PMTCT but were either unable to afford or afraid to register. Addressing the identified challenges will not only be important for integrated PMTCT/ANC services but will also provide a model for dealing with challenges as countries scale up ‘treat all’ approaches.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1898-7) contains supplementary material, which is available to authorized users.

Factors impacting antenatal care utilization: a systematic review of 37 fragile and conflict-affected situations

“…One commonly cited other factor was husband’s education and employment, where women whose partners had higher levels of education or formal employment had increased usage of ANC [ 38 ]. Unwanted pregnancies [ 45 , 73 , 76 ], stigma from the community or family members [ 36 , 50 , 74 ], community members advising against using formal ANC services [ 21 , 77 ], use of traditional healers [ 47 , 77 ], lack of awareness and knowledge [ 31 , 38 , 78 , 79 ] and performance-based financing interventions [ 80 , 81 ] were additional factors associated with delayed and less frequent use of ANC.…”

Socio-Demographics and Late Antenatal Care Seeking Behavior: A Cross Sectional Study among Pregnant Women at Kyenjojo General Hospital, Western Uganda

“…The current study also upon controlling for confounders indicates that religion had no significant association with late ANC attendance. Other studies in South African and Zimbabwe suggest that culture and religion influence ANC attendance and that the practices attached to these beliefs tend to delay ANC initiation [20] [21].…”

Direct and opportunity costs related to utilizing maternity waiting homes in rural Zambia

“…However, the literature is more mixed regarding user fees. Some studies suggest women are willing to financially contribute to their stay at a MWH, while others suggest that user fees will impede access, especially for the poor ( Borghi et al., 2006 ; Sibanda et al., 2018 ). A qualitative study based on the gathered perspectives of pregnant women, mothers, health care workers, and community members showed that participants at MWHs express a concern that women will be deterred by user fees because other reproductive health services have been free in Zambia since 2006 ( Chibuye et al., 2018 ).…”

“…A systematic review regarding drivers and deterrents of facility-based delivery in sub-Saharan Africa found that women with high household wealth and high socioeconomic status were more likely to use facility-based delivery ( Moyer and Mustafa, 2013 ). High fees have also been identified as barriers to access antenatal and postnatal care services ( Sacks et al., 2017 ; Sibanda et al., al.,2018 ). Consequently, the low utilisation of key reproductive health services contributes to the high maternal mortality and morbidity that are fundamentally preventable in LICs ( Sacks et al., 2017 ).…”