Main Article Content
Barriers, Antenatal Care, Primary Health Care, Basrah
Introduction: Antenatal care (ANC) includes preventive and curative care services delivered during pregnancy. The World Health Organization (WHO) suggests that pregnant women should receive at least four ANC visits. ANC is provided in Iraq in the public sector mainly in primary health care (PHC) centers with referral to higher care if required. Private sector contributes to ANC, both private clinics and private hospitals have outpatient services as well.
Objectives: This study aims to describe the ANC use among women attending PHC centers in Basrah, determine associations of ANC utilization rate with sociodemographic characteristics, and ascertain barriers to the utilization of ANC services at the PHC centers in Basrah.
Methods: This is a descriptive cross-sectional study carried out among 322 mothers (with children aged below two years) attending four PHC facilities in rural areas of Basrah. Data was collected through direct interview of the mothers by the investigator.
Results: The study found that 15.8% of the mothers in rural areas of Basrah made no ANC visits to the PHC centers, 44.8% had between one to three visits, and just over one third received the recommended four or more ANC visits (39.4%). The study found significant association of ANC services utilization in PHC centers with number of children, mother’s occupation, family income and woman’s desire for pregnancy (p < 0.05). The most reported barriers by mothers to availing ANC services included: preference of private medical care, difficult to leave elder children, no one accompany, laziness, ignorance, forgetfulness, lack of authorization by husband, distance to health center, health-related barrier and transportation barrier.
Conclusion: This study found that ANC services in PHC centers were underutilized. Intervention aimed at raising women’s awareness of the significance of ANC services and improving utilization, especially in rural areas, is necessary.
Keywords: Barriers, Antenatal Care, Primary Health Care, Basrah
2. WHO Global Health Observatory (GHO), Antenatal care situation and trends, Geneva: WHO.2011; Available at https://www.who.int/gho/maternal_health/reproductive_health/antenatal_care/en accessed April, 16, 2020.
3. de Fonseca CR, Strufaldi MW, de Carvalho LR, Puccini RF. Adequacy of antenatal care and its relationship with low birth weight in Botucatu, São Paulo, Brazil: a case-control study. BMC Pregnancy Childbirth. 2014; 14:255–266.
4. Bhaskar RK, Deo kk, Neupane U, Chaudhary Bhashkar S. Yadav BK, Pokharel HP, et al. A case control study on risk factors associated with low birth weight babies in Eastern Nepal. Inter J Paediatr. 2015. Available from: doi: org/10.1155/2015/807373.
5. World Health Organization. Recommendations on Antenatal Care for a Positive Pregnancy Experience, World Health Organization: Geneva, Switzerland, 2016.
6. WHO | More women worldwide receive early antenatal care, but great inequalities remain. 2017; Available at https://www.who.int/reproductivehealth/early-anc-worldwide/en accessed April10, 2020.
7. Finlayson K, Downe S. Why do women not use antenatal services in low-and middle income countries? A meta-synthesis of qualitative studies. PloS Med.2013; 10(1):e1001373.
8. Maternal mortality - World Health Organization. 2019; Available at https://www.who.int/news-room/fact-sheets/detail/maternal-mortality accessed April 3, 2020.
9. Iraq’s reproductive maternal, newborn, child and adolescent health. 2019; Available at https://www.moh.gov.iq/upload/upfile/ar/1000.pdf accessed April, 5, 2020.
10. Hossain S, El Nakib S, Ibrahim S, Al-Harun A, Muhammad S, Zaka N, et al. Maternal and neonatal health in select districts of Iraq: findings from a recent household survey. J Preg Child Health. 2018; 5(5):395–402.
11. World Health Organization Reproductive Health Indication; Guidelines for their generations intervention and analysis for global monitoring.2000; Available at http://www.Who-int/reproductive health/publications/rh-indicators/guidlines.pdf, accessed April, 9, 2020.
12. Nwabueze A, Nnebue C, Ubajaka C, IIika A. Constraints to utilization of maternal health services at the primary health care level in New, Nigeria.Orient Journal of Medicine. 2014;26 (3-4):99-106.
13. Mrisho M, Obrist B, Schellenberg JA, Haws RA, Mushi AK, Mshinda H, et al. The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania. BMC Pregnancy Childbirth. 2009 Mar 4; 9:10–21.
14. Atuyambe L, Mirembe F, Annika J, Kirumira EK, Faxelid E. Seeking safety and empathy: adolescent health seeking behavior during pregnancy and early motherhood in central Uganda. J Adolesc. 2009 Aug; 32(4): 781–96.
15. Tinoco-Ojanguren R, Glantz NM, Martinez-Hernandez I, Ovando-Meza I. Risk screening, emergency care, and lay concepts of complications during pregnancy in Chiapas, Mexico. Soc Sci Med.2008 Mar; 66(5):1057–69.
16. Agus Y, Horiuchi S. Factors influencing the use of antenatal care in rural West Sumatra, Indonesia. BMC Pregnancy and Childbirth. 2012 Feb 21; 12(9).Available from: doi:org/10.1186/1471-2393-12-9.
17. Moore N, Blouin B, Razuri H, Casapia M, Gyorkos TW. Determinants of first trimester attendance at antenatal care clinics in the Amazon region of Peru: A case-control study. PLoS One.2017 Feb 16;12(2):e0171136.
18. Matsuoka S, Aiga H, Ramsey LC, Rathavy T, Okitsu A. Perceived barriers to utilization of maternal health services in rural Cambodia. Health Policy. 2010 May; 95(2–3):255–63. Available from :doi:10.1016/j.healthpol.2009.12.011.
19. Kisuule I, Kaye DK, Najjuka F, Ssematimba SK, Arinda A, Nakitende G, et al. Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala Uganda. BMC Pregnancy Childbirth. 2013 May 25; 13:121–127.
20. Andrew EV, Pell C, Angwin A, Auwun A, Daniels J, Mueller I, et al. Factors affecting attendance at and timing of formal antenatal care: results from a qualitative study in Madang, Papua New Guinea. PLoS One. 2014 May 19; 9(5):e93025.
21. Daniel W W. Biostatistics basic concepts and methodology for the health sciences.9th ed. Asia: Wiley; 2010. 594–629p.
22. Ebonwu J, Mumbauer A, Uys M, Wainberg ML, Medina-Mario A. Determinants of late antenatal care presentation in rural and peri-urban communities in South Africa: A cross-sectional study. PLOS ONE. 2018 March; 13(3):e0191903.
23. Yasuoka J, Nanishi K, Kikuchi K, Suzuki S, Ly P, Thavrin B, et al. Barriers for pregnant women living in rural, agricultural villages to accessing antenatal care in Cambodia: A community-based cross-sectional study combined with a geographic information system. PLOS ONE. 2018 March 19;13(3):e0194103.
24. Rurangirwa AA, Mogren I, Nyirazinyoye L, Ntaganira J, Krantz G. Determinants of poor utilization of antenatal care services among recently delivered women in Rwanda; a population based study. BMC Pregnancy Childbirth. 2017 May 15; 17(1):142–151.
25. Yeji F, Shibanuma A, Oduro A, Debpuur C, Kikuchi K, Owusu-Agei S, et al. Continuum of Care in a Maternal, Newborn and Child Health Program in Ghana: Low Completion Rate and Multiple Obstacle Factors. PLOS ONE. 2015 Dec9; 10(12):e0142849.
26. Gudayu TW, Woldeyohannes SM, Abdo AA. Timing and factors associated with first antenatal care booking among pregnant mothers in Gondar Town; North West Ethiopia. BMC Pregnancy Childbirth.2014 Dec;14(1):287–293.
27. Mclntyre P, World Health Organization. Pregnant adolescents: delivering on global promises of hope. Geneva: World Health Organization; 2006.
28. Berhe A, Bayray A, Berhe Y, Teklu A, Desta A, Araya T, et al. Determinants of postnatal care in Tigray, Northern Ethiopia: A community-based cross sectional study. PLoS. 2019 Aug; 14(8): e 0221161.
29. King-Schultz L, Jones-Webb R. Multi-method approach to evaluate inequities in prenatal care access in Haiti. J Health Care Poor Underserved. 2008; 19:248–257.
30. Titaley CR, Hunter CL, Heywood P, Dibley MJ. Why don’t some women attend antenatal and postnatal care services? A qualitative study of community members’ perspectives in Garut, Sukabumi and Ciamis districts of West Java Province, Indonesia. BMC Pregnancy Childbirth. 2010; 10: 61–72.
31. Taneja G, Sridhar VSR, Mohanty JS, Joshi A, Bhushan P, Jain M. India’s RMNCH+ A Strategy: Approach, learnings and limitations .BMJ GlobHealth. 2019; 4: e001162.
32. Banda I, Michelo C, Hazemba A. Factors associated with late antenatal care attendance in selected rural and urban communities of the copperbelt province of Zambia. Med J Zambia. 2014;39(3):29–36.
33. Ogbo F, Dhami M, Ude E, Senanayake P, Osuagwu U, Awosemo A, et al. Enablers and barriers to the utilization of antenatal care services in India. Int J Environ Res Public Health.2019;16;3152–3165.
34. Agha S, Wiliiam E, Quality of antenatal care and household wealth as determinants of institutional delivery in Pakistan: Results of a cross-sectional household survey. Reprod Health. 2016; 13: 84–91.