Barriers to health-seeking practices during pregnancy among adolescents in rural Blantyre, Malawi

Abstract

Background Very few adolescents in Malawi seek antenatal care on time during pregnancy. The Kroeger model (1993) guided the investigation of factors that hinder adolescents from seeking healthcare advice during pregnancy. Method A cross-sectional study was conducted at three health centers in rural Blantyre involving a convenience sample of 240 respondents. Data were analysed using SPSS version 16.0. Results Individual factors such as low level of education, inability to make decisions with regards to care, inadequate knowledge, and psychological factors such as shyness, fear, stigma and health service factors such as long distance to the facility, a lack of adolescent friendly services, and inaccessible roads were found to be barriers to seeking healthcare. Conclusion Empowering communities and adolescents, establishing and making existing health facilities more adolescent friendly may help adolescents seek healthcare advice in suitable time during pregnancy.

Access barriers to obstetric care at health facilities in sub-Saharan Africa—a systematic review

“…Jacobs et al [ 11 ] explain that services such as counselling and provision of consumer information on health services could help address barriers related to availability. Availability barriers were expressed in various forms, such as perceiving health facility-based care which was not different from other options/alternatives [ 78 ]; being unaware of care, type and nature of services [ 22 , 28 , 47 , 78 – 83 ] and having limited media exposure [ 22 , 79 , 84 ].…”

“…Social problems related to women’s low self-esteem and assertiveness were highly reported and manifested in various forms such as the husband’s denial of permission, the need for the husband’s/relative’s permission, women’s low decision-making power/autonomy [ 22 , 23 , 27 – 29 , 33 , 39 , 46 , 49 , 51 , 60 , 62 , 64 , 66 , 68 , 69 , 71 , 73 , 78 – 80 , 94 , 97 , 104 , 110 , 111 , 114 – 122 ] and delayed/ineffective decision-making within the family [ 47 , 56 , 65 , 123 , 124 ]. Shyness, fear or shame were also reported [ 28 , 113 ], particularly among sub-groups like teenagers who were possibly afraid of being reprimanded. In an isolated instance, a study by Anyait et al [ 38 ] indicates that women’s autonomy in decision-making promoted antenatal attendance but reduced the likelihood of delivery in health facilities.…”

“…Stigma is often associated with particular groups of people in society who may feel vulnerable or have negative attitudes/perceptions about specific social, medical or other problems. For instance, among adolescents, stigma may lead to fear of disclosing pregnancy [ 28 ] or non-use of services as a result of feeling shame [ 49 ]. Others include fear of HIV-related stigma in pregnancy [ 83 , 94 , 136 , 137 ].…”

“…Generally, a low-level of formal education of a woman, husband, couple or household head was a significant barrier to using antenatal, delivery or postnatal services, whereas secondary school and above level of education was associated with better utilisation of maternity services [ 28 , 34 , 39 , 58 , 67 , 70 , 73 , 75 , 78 – 82 , 84 , 85 , 88 , 90 , 92 , 94 , 95 , 99 – 101 , 103 , 106 , 108 , 113 , 117 , 124 , 127 , 130 , 132 , 134 , 138 – 144 ].…”

Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey

“…In relation to the problems experienced by women in accessing healthcare, the following four major problems have been addressed in previous studies: obtaining permission, 19 20 obtaining money, 21 distance to the health facility 22 and not wanting to go alone (lack of spouse or family member escort). 23 24 Although it is unclear whether women with multiple problems encounter greater difficulties in accessing healthcare, most previous studies assessed and discussed each of these four problems independently.…”