Barriers to Antenatal Care in an Urban Community in the Gambia: An In-depth Qualitative Interview Study

Susan P. Laing, Smruti V. Sinmyee, Khizar Rafique, Helen E. Smith, Max J. Cooper

Abstract

This qualitative study investigated the barriers to obtaining access to antenatal care in a small, urban government-supported health centre in the Gambia. It thus addresses an important issue related to maternal health and the prevention of maternal deaths. In-depth interviews were conducted with 25 pregnant women, 13 healthcare workers and 9 male partners. Three areas were identified for study: recognition and acknowledgment of pregnancy, recognition of the need for care and practical barriers to attendance. Intentional concealment of early pregnancy was common to avoid adverse social consequences or for fear that malign interventions would cause a miscarriage. In the absence of symptoms many women considered it unnecessary to attend the antenatal clinic until well into the second trimester. Practical barriers to attendance included conflicting domestic demands and the attitude of some healthcare workers. Access to antenatal care in the Gambia throughout pregnancy should be considered in a stepwise fashion and barriers to care were identified at each stage. Interviews with male partners and health workers highlighted their key role. (Afr J Reprod Health 2017; 21[3]:62-69).

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References

United Nations Children's Emergency Fund (UNICEF) - At a glance: Gambia - Statistics 2013 [01 February 2015]. Available from: http://www.unicef.org/infobycountry/gambia_statistics.html.

Africa - Sub-Saharan Africa's maternal death rate down 41 per cent: United Nations Population Fund (UNFPA); 2012 [01 February 2015]. Available from: http://africa.unfpa.org/public/cache/offonce/news/pid/10767.

Antenatal care in developing countries. Promises, achievements and missed opportunities. An analysis of trends, levels and differentials 1990-2001. WHO 2003 ISBN 92 4 159094 7

Gage AJ. Barriers to the utilization of maternal health care in rural Mali. Social Science and Medicine. 2007; 65(8):1666-82.

Grossmann-Kendall F, Filippi V, DeKoninck M and Kanhonou L. Giving birth in maternity hospitals in Benin: testimonies of women. Reproductive Health Matters. 2001; 9(18):90-98

Stokes E, Dumbaya I, Owens S and Brabin L. The right to remain silent: a qualitative study of the medical and social ramifications of pregnancy disclosure for Gambian women. British Journal of Obstetrics and Gynaecology. 2008; 115(13):1641-7.

Pell C, Menaca A, Were F, Afrah NA, Chatio S, Manda-Taylor L, Hamel MJ, Hodgson A, Tagbor H, Kalilani L, Ouma P and Pool R. Factors Affecting Antenatal Care Attendance: Results from Qualitative Studies in Ghana, Kenya and Malawi. Public Library of Science (PLoS) One. 2013; 8(1): e53747

Jansen I. Decision making in childbirth: the influence of traditional structures in a Ghanaian village. International Nursing Review. 2006; 53(1):41-6.

De Allegri M, Ridde V, Louis VR, Sarker M, Tiendrebeogo J, Ye M, Müller O and Jahn A. Determinants of utilisation of maternal care services after the reduction of user fees: a case study from rural Burkina Faso. Health Policy. 2011; 99(3):210-8.

Mubyazi GM, Bloch P, Magnussen P, Olsen E, Byskov J, Hansen KS and Bygberg IC. Women's experiences and views about costs of seeking malaria chemoprevention and other antenatal services: a qualitative study from two districts in rural Tanzania. Malaria Journal. 2010; 9:54.

Prata N, Greig F, Walsh J and West A. Ability to pay for maternal health services: what will it take to meet WHO standards? Health Policy. 2004; 70(2):163-74.

Hodgkin D. Household characteristics affecting where mothers deliver in rural Kenya. Health Economics. 1996; 5(4):333-40.

Nikiéma B, Beninguisse G and Haggerty JL. Providing information on pregnancy complications during antenatal visits: unmet educational needs in sub-Saharan Africa. Health Policy and Planning. 2009; 24(5):367-76.

Rai RK, Singh PK and Singh L. Utilization of maternal health care services among married adolescent women: insights from the Nigeria Demographic and Health Survey, 2008. Womens Health Issues. 2012; 22(4):e407-14.

Gross K, Alba S, Glass TR, Schellenberg JA and Obrist B. Timing of antenatal care for adolescent and adult pregnant women in south-eastern Tanzania. BMC Pregnancy and Childbirth. 2012; 12:16.

Guest G, MacQueen KM and Namey EE. Introduction to Applied Thematic Analysis. Applied Thematic Analysis. 1st ed. Los Angeles: Sage Publications; 2012.

Anya SE, Hydara A and Jaiteh LES. Antenatal care in the Gambia: Missed opportunity for information, education and communication. BMC Pregnancy and Childbirth, 2008; 8:9.

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