Barriers to Utilization of Antenatal Care Services in Eastern Nepal

Abstract

BackgroundWorld Health Organization recommends at least four pregnancy check-ups for normal pregnancies. Ministry of Health and Population Nepal has introduced various strategies to promote prenatal care and institutional delivery to reduce maternal and child deaths. However, maternal health service utilization is low in some selected socio-economic and ethnic groups. Hence, this study aims to assess barriers to the recommended four antenatal care (4ANC) visits in eastern Nepal.MethodsA cross-sectional quantitative study was conducted in Sunsari district. A total of 372 randomly selected women who delivered in the last year preceding the survey were interviewed using a semi-structured questionnaire. Bivariate and multivariate logistic regression analysis was carried out to identify barriers associated with 4ANC visits.ResultsMore than two-third women (69%) attended at least 4ANC visits. The study revealed that women exposed to media had higher chance of receiving four or more ANC visits with an adjusted odds ratio (aOR = 3.5, 95% CI: 1.2–10.1) in comparison to women who did not. Women from an advantaged ethnic group had more chance of having 4ANC visits than respondents from a disadvantaged ethnic group (aOR = 2.4, 95% CI: 2.1–6.9). Similarly, women having a higher level of autonomy were nearly three times more likely (aOR = 2.9, 95% CI: 1.5–5.6) and richer women were twice (aOR = 2.3, 95% CI: 1.1–5.3) as likely to have at least 4ANC visits compared to women who had a lower level of autonomy and were economically poor.ConclusionBeing from disadvantaged ethnicity, lower women’s autonomy, poor knowledge of maternal health service and incentive upon completion of ANC, less media exposure related to maternal health service, and lower wealth rank were significantly associated with fewer than the recommended 4ANC visits. Thus, maternal health programs need to address such socio-cultural barriers for effective health care utilization.

Demographic and Socio-economic Factors Affecting Antenatal Care Services Utilization in Nepal

“…Women from middle category are also more likely to utilize ANC services 4 or more times than poor category women. Similar finding is drawn in the analysis of a cross sectional quantitative study conducted in Sunsari district of eastern Nepal (Deo et al, 2015).…”

“…The finding on the effect of place of residence on ANC utilization is consistent with the finding of studies conducted in Nepal and other countries (Kaule-sabiti, Acheampong & Ngake, 2014;Rahman, 2009;Kulkarni & Nimbalkar, 2008;Baral, Lyons, Skinner, & VanTeijlingen, 2012). The other social variables like level of women's education and access to media also have shown strong effects in Nepal which is confirmed by a study conducted in Nepal by Deo et al (2015). Strong effect of educational level on ANC utilization is also found in Ethiopia (Tura, Afework & Yalew, 2014).…”

“…The literature on utilization of ANC services in a number of developing countries (Chauhan, 2012;Deo et al, 2015;Mehari, 2013) has exhibited the effects of several demographic, social and economic factors whether women utilize or not utilize these services. The studies have indicated that demographic variables like woman's age, inter-birth intervals and children ever born (CEB) are predictors of the use of ANC (IIPS, 2010).…”

“…Few research studies have been conducted in Nepal on aspects of ANC care including demographic and socio-economic factors affecting the utilization of ANC care by women (Pandey & Karki, 2014;Deo et al, 2015). The finding of these studies however is limited either to specific geographical locations, communities or only a few districts.…”

Women autonomy and maternal healthcare services utilization among young ever-married women in Nigeria

“…The challenge of reducing maternal mortality remains a major health problem in Nigeria and recent statistics from national surveys show that in 2008 the estimated maternal mortality ratio (MMR) was 545 /100,000 livebirths while in 2013 it estimated to be 576 /100,000 live births implying that the ratio increased between that fiveyear period and Nigeria did not achieve the millennium development goal 4 of improving maternal health (WHO, 2015). Literature has established utilisation of maternal health care services such as antenatal care visits, place of delivery (delivery at health facility) and postnatal care received from skilled health workers as veritable and effective way of reducing the risk of maternal mortality and morbidity (Bayu et al, 2015;Deo et al, 2015;Hagos et al, 2014;Ochako et al, 2011;Situ, 2013).…”