Postnatal mothers' perceived enablers and barriers to early antenatal care and contact times at Salima hospital

Abstract

Introduction Delayed access and underutilization of antenatal care remain a challenge in Malawi despite being the risk factor to high maternal and neonatal mortality. The new World Health Organization’s (WHO’s) antenatal care (ANC) Model recommends timely initiation of ANC and attainment of at least eight contacts. In Malawi, antenatal care initiation and 4 plus contacts are at 28% and 51%, with 1% attaining 8 ANC contacts. Salima District Hospital accounted for 12% and 30%, respectively. Broad objective: To assess postnatal mothers’ perceived enablers and barriers to early antenatal care and contact times at Salima Hospital. Methods: A mixed method study approach employing a convergent design was used. Quantitative data were collected from 68 participants sampled randomly while 12 other participants were purposively sampled for focus group discussions. Quantitative and qualitative data analyses were done using Statistical Package for Social Science (SPSS) and thematic analysis, respectively.

Results: Of the women who participated in the study, 68% perceived the first trimester as the recommended time for initiating ANC, although only 28% followed through. About 69% had poor perception of ANC contacts, and 3% adhered. Previous complications and frequent schedules were the only statistically significant enablers for early ANC initiation and more contacts, p value 0.021 and 0.001, while lack of knowledge regarding the recommended time for initiating ANC, unplanned pregnancy and individual decision were statistically significant barriers, p value 0.020, 0.033 and 0.000, respectively. On qualitative study findings, seven main themes emerged: traditional beliefs, health care related, protection of self and unborn baby, poor socioeconomic status, individual negligence, and unplanned pregnancy. Conclusion: Despite good perception about ANC initiation and contact times most women could not adhere. Reinforcement of awareness campaigns on new WHO ANC model would promote adherence. Key words: Early antenatal care, perceived enablers and barriers, postnatal mothers