Factors Associated with Four or More Antenatal Care Visits and Its Decline among Pregnant Women in Tanzania between 1999 and 2010

Abstract

In Tanzania, the coverage of four or more antenatal care (ANC 4) visits among pregnant women has declined over time. We conducted an exploratory analysis to identify factors associated with utilization of ANC 4 and ANC 4 decline among pregnant women over time. We used data from 8035 women who delivered within two years preceding Tanzania Demographic and Health Surveys conducted in 1999, 2004/05 and 2010. Multivariate logistic regression models were used to examine the association between all potential factors and utilization of ANC 4; and decline in ANC 4 over time. Factors positively associated with ANC 4 utilization were higher quality of services, testing and counseling for HIV during ANC, receiving two or more doses of SP (Sulphadoxine Pyrimethamine)/Fansidar for preventing malaria during ANC and higher educational status of the woman. Negatively associated factors were residing in a zone other than Eastern zone, never married woman, reported long distance to health facility, first ANC visit after four months of pregnancy and woman's desire to avoid pregnancy. The factors significantly associated with decline in utilization of ANC 4 were: geographic zone and age of the woman at delivery. Strategies to increase ANC 4 utilization should focus on improvement in quality of care, geographic accessibility, early ANC initiation, and services that allow women to avoid pregnancy. The interconnected nature of the Tanzanian Health System is reflected in ANC 4 decline over time where introduction of new programs might have had unintended effects on existing programs. An in-depth assessment of the recent policy change towards Focused Antenatal Care and its implementation across different geographic zones, including its effect on the perception and understanding among women and performance and counseling by health providers can help explain the decline in ANC 4.

Determinants of attending antenatal care at least four times in rural Ghana: analysis of a cross-sectional survey

“…Therefore, in the Dodowa area, women who lived long distances from a health facility but experienced unwanted pregnancies could have been reluctant to walk to health facilities for ANC services. In addition, absence of a pregnancy ‘mindset,’ which is common in unexpected or unwanted pregnancy, could have exerted a negative influence on women’s use of ANC services [7,39]. …”

“…ANC attendance is influenced by geographical, socioeconomic, religious, cultural, and demographic factors [7–9]. For instance, lower educational levels [9] and socioeconomic factors [2,7] are associated with poor ANC attendance in women in rural areas [2,10].…”

“…For instance, lower educational levels [9] and socioeconomic factors [2,7] are associated with poor ANC attendance in women in rural areas [2,10]. Spousal support and decisions concerning the use of maternal health services also influence women’s access to skilled care [11].…”

“…This could be attributed to the patriarchal system in place in Africa, in which men are usually the heads of households, with the power and authority to make decisions, including those concerning their wives’ use of maternal health services [12–16], for their family members [13]. Religious factors also contribute to women’s decisions regarding ANC attendance [7]. Religion is considered a form of healing and, in some instances, offers interventions for some diseases.…”

Timing and reasons for antenatal care booking among women in a tertiary health care center in Southern Nigeria

“…11,12 Early booking for antenatal care is also positively associated with four or more visits and such parturient are more likely to be assisted by a skilled attendant at birth. 13,14 Early booking is therefore a strong predictor of positive pregnancy outcome.…”