Factors for late initiation of antenatal care in Dar es Salaam, Tanzania: A qualitative study
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Date
2019-11-12
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Springer Nature
Abstract
Background: Antenatal care (ANC) provided by a trained health care provider is important for monitoring
pregnancy thereby reducing potential risks for the mother and child during pregnancy and delivery. The World
Health Organization (WHO) recommends at least four ANC visits to all pregnant women. While the proportion of
women who attend at least one ANC in low-income countries is high, most pregnant women start their first ANC
attendance very late. In Tanzania only 24% of pregnant women start their first ANC attendance before the fourth
month of pregnancy. While factors for the utilization of antenatal care in general have been widely studied, there is
paucity of studies on the factors affecting timing of the first ANC attendance. This study aimed to understand
individual, community, and health system factors that lead to the delay in seeking ANC services among pregnant
women in Ilala Municipal in Dar es Salaam region, Tanzania.
Methods: A qualitative exploratory study, using in-depth interviews with 20 pregnant women and five health care
workers was conducted in three different health facilities in Dar es Salaam Tanzania. Thematic analysis approach
was used to analyse the data.
Results: Individual perceptions of antenatal care, past experience with pregnancy, fear of pregnancy disclosure, and
socio-cultural beliefs were the key individual and social factors for late ANC attendance. Shortage of trained health
care workers, lack of spouse’s escort and health providers’ disrespect to pregnant women were the main health
system barriers to early ANC attendance.
Conclusions: This study concludes that community members should be sensitized about the importance of early
ANC attendance. Additionally, while spouse’s escort policy is important for promoting PMTCT, the interpretation of
the policy should not solely be left to the health providers. District and regional health officials should provide
correct interpretation of this policy.
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Keywords
Antenatal Care, Factors for late initiation, health system, Tanzania