Why pregnant women delay to initiate and utilize free antenatal care service: a qualitative study in the Southern District of Mzimba, Malawi

Abstract

AIM: The study aimed to explore factors related to the initiation and utilization of focused antenatal care (FANC) in the Southern District of Mzimba, Malawi. METHODS: This study used an exploratory qualitative design. Total of 22 in-depth interviews with pregnant women and community midwife assistants were conducted from December 2015 to January 2016 in Mzimba. Thematic analysis approach was adopted to identify the facilitator and barriers of the FANC initiation and utilization. RESULTS: Facilitator of FANC initiation and utilization included seeking pregnancy confirmation, medical treatment for an existing health problem and the support by community health extension workers. Barriers included the additional cost to free FANC service, lack of essential equipment, unfriendly adolescent reproductive health service, and HIV stigma. CONCLUSION: Early initiation of FANC relies on both woman’s awareness and community support. Promoting the use of FANC should focus on creating an enabling environment, e.g., increasing investment of essential med- ical equipment, reducing additional costs of FANC services, eliminating the discrimination against adolescent pregnancy and people living with HIV, and strengthening health personnel’s training.