Determinants of utilization of antenatal care services in developing countries

Background: Utilization of antenatal care services is very essential for reducing maternal mortality in a country like India which is experiencing high maternal mortality especially in the state of Assam being at the top position. Almost 90% of the maternal deaths can be prevented by timely medical interventions. However, adequate utilization of antenatal care (ANC) services is far away from WHO recommendations. The objective is to assess the utilization of antenatal care services and also to determine the underlying factors influencing the utilization of antenatal care services in rural areas of Assam.Methods: A cross sectional study was conducted from September-December 2015. Eight villages were selected randomly and sample size was calculated as 300.All currently married women having children of less than one year of age comprised of study population. Results: Out of 300 women all were registered during antenatal period and among them 53% were registered during first trimester. Among them 68.7% women had more than three antenatal visits, 90% were immunized with TT and 71.6% had consumed 100 or more IFA tablets. The utilization of antenatal care services were found to be significantly associated with the age of the women , religion, caste, socioeconomic class, place of delivery, mode of delivery, parity (P<0.05).Conclusions: The present study revealed that factors like age, religion, caste, socioeconomic status, place of delivery, parity were associated with utilization of antenatal care services. Government should make effort to increase the level of awareness and knowledge among the women about the adequate utilization of antenatal care services.

Background: PMSMA was launched by the Ministry of Health and Family Welfare, Government of India to improve the quality and coverage of antenatal care as part of RMNCH+A to reduce MMR. It is an initiative to help pregnant women especially from backward classes, rural areas and belonging to the unprivileged group, in remaining healthy throughout their pregnancy. Objective: 1. To assess the utilization of antenatal care services at PMSMA clinic on 9th of each month. 2. To know factors associated with the utilization of services in PMSMA clinic. Methods: A cross-sectional study was carried out in February-April 2018 among 161 mothers who had delivered within one year from the date of the study and who had registered and availed ANC services at Rural field practice area of BIMS, Belagavi. Mothers were selected using systematic sampling. After obtaining an informed, written consent from the eligible participants, data was collected regarding utilization of ANC services and the quality of care received by them. The collected data was compiled, tabulated and analyzed in MS Excel and SPSS. The results are presented as percentage and proportion and chi-square test has been applied. Results: Majority of participants belonged to the age group 20-30 years. Majority were Hindu by religion and belonged to low socio-economic class. ANC services under PMSMA were utilized by 32% participants. The utilization of services under PMSMA was found to be significantly associated with the type of family of the participant and awareness regarding the same.

This research conducted to determine the utilization of antenatal care services among pregnant women attending specialist hospital Bauchi state. Three research objectives and three research questions guided the study. Literature where review on effects of culture on ANC services, socio economic factors on utilization of ANC services and attitudes and health care services on the utilization of ANC services among pregnant women. The study adopted description research survey design and purposive sampling technique was used to select 90 patients from the study area. The instrument used for the data collection was structured questionnaire. 90 questionnaires were distributed to 90 respondents with the help of research assistance. The data collected was analyzed using frequency distribution table and percentage. Based on the research findings, it was revealed that cultural belief of different kind, low socio-economic status and attitude of healthcare providers are factors that influence the utilization of antenatal care services among pregnant women attending specialist hospital Bauchi. the findings the researcher recommended that the health care provider should help in educating the pregnant women on the need and importance of antenatal clinic attendance, culture and religious belief that can affect health negatively should be discouraged through community mobilization and participation towards factors that are harmful to health. Adequate provision of qualified health personnel to manage the health facilities and health unit should be fully equipped. finally, Government should do much within its limited resources to provide free ANC services at all level of health institutions and to all groups of pregnant women and Community religious, leaders should be involved in promoting ANC services.

IntroductionDespite the international emphasis in the last few years on the need to address the unmet health needs of pregnant women and children, progress in reducing maternal mortality has been slow. This is particularly worrying in sub-Saharan Africa where over 162,000 women still die each year during pregnancy and childbirth, most of them because of the lack of access to skilled delivery attendance and emergency care. With a maternal mortality ratio of 673 per 100,000 live births and 19,000 maternal deaths annually, Ethiopia is a major contributor to the worldwide death toll of mothers. While some studies have looked at different risk factors for antenatal care (ANC) and delivery service utilisation in the country, information coming from community-based studies related to the Health Extension Programme (HEP) in rural areas is limited. This study aims to determine the prevalence of maternal health care utilisation and explore its determinants among rural women aged 15–49 years in Tigray, Ethiopia.MethodsThe study was a community-based cross-sectional survey using a structured questionnaire. A cluster sampling technique was used to select women who had given birth at least once in the five years prior to the survey period. Univariable and multivariable logistic regression analyses were carried out to elicit the impact of each factor on ANC and institutional delivery service utilisation.ResultsThe response rate was 99% (n=1113). The mean age of the participants was 30.4 years. The proportion of women who received ANC for their recent births was 54%; only 46 (4.1%) of women gave birth at a health facility. Factors associated with ANC utilisation were marital status, education, proximity of health facility to the village, and husband’s occupation, while use of institutional delivery was mainly associated with parity, education, having received ANC advice, a history of difficult/prolonged labour, and husbands’ occupation.ConclusionsA relatively acceptable utilisation of ANC services but extremely low institutional delivery was observed. Classical socio-demographic factors were associated with both ANC and institutional delivery attendance. ANC advice can contribute to increase institutional delivery use. Different aspects of HEP need to be strengthened to improve maternal health in Tigray.

The study aimed to identify the factors influencing the utilization of antenatal care (ANC) services among pregnant women to fulfill the Sustainable Development Goals (SDG) for maternal mortality ratio (MMR) by 2030; we also investigated the consistency of these factors. We have used the Demographic and Health Survey (DHS) data from 29 developing countries for analysis. A binary logistic regression model was run using Demographic and Health Survey data from Bangladesh to determine the factors influencing ANC utilization in Bangladesh. In addition, a random-effects model estimation for metaanalysis was performed using DHS data from 29 developing to investigate the overall effects and consistency between covariates and the utilization of ANC services. Logistic regression revealed that residence (odds ratio [OR] 1.436; 95% confidence interval [CI] 1.238, 1.666), respondent's education (OR 3.153; 95% CI 2.204, 4.509), husband's education (OR 2.507; 95% CI 1.922, 3.271) wealth index (OR 1.485; 95% CI 1.256, 1.756), birth order (OR 0.786; 95% CI 0.684, 0.904), working status (OR 1.292; 95% CI 1.136, 1.470), and media access (OR 1.649; 95% CI 1.434, 1.896) were the main significant factors for Bangladesh. Meta-analysis showed that residence (OR 2.041; 95% CI 1.621, 2.570), respondent's age (OR 1.260; 95% CI 1.106, 1.435), respondent's education level (OR 2.808; 95% CI 2.353, 3.351), husband's education (OR 2.267; 95% CI 1.911, 2.690), wealth index (OR 2.715; 95% CI 2.199, 3.352), birth order (OR 1.722; 95% CI 1.388, 2.137), and media access (OR 2.474; 95% CI 2.102, 2.913) were the most conclusive factors in a subjects decision to attend ANC. Our results support the augmentation of maternal education and media access in rural areas with ANC services. Particular focus is needed for women from Afghanistan since they have a lower level of ANC services.

To investigate the temporal trend of socioeconomic and rural-urban disparities and geographical variation in the utilization of antenatal care (ANC) services in India before and throughout the Millennium Development Goals era. For this temporal analysis, secondary data from the Indian National Family Health Surveys between 1998 and 2015 (Waves 2, 3, and 4) were used. We analyzed the trend in inequality for at least one and four ANC visits to a health care professional (ANC1+ and ANC4+, respectively) by education, wealth, and residence type. Multilevel logistic regression models were used to assess the temporal trend and the relative contribution of communities and states to the overall variation in ANC1+ and ANC4+. Data on utilization of ANC services for the last birth of women aged 15-49years during the three or five years preceding the survey (depending on the survey year) were used. Educational and wealth inequality in ANC1+ and ANC4+ worsened between 1998 and 2005 and improved between 2005 and 2015 (for ANC4+, OR [95% CI]=0.22 [0.19-0.25] in Wave 2; OR [95% CI]=0.19 [0.17-0.22] in Wave 3; and OR [95% CI]=0.38 [0.36-0.40] in Wave 4 for the poorest). Rural-urban inequality showed a consistent decline (for ANC4+, OR [95% CI]=0.59 [0.54-0.64] in Wave 2; OR [95% CI]=0.63 [0.59-0.68] in Wave 3; and OR [95% CI]=0.82 [0.79-0.85] in Wave 4 for rural area). The relative contribution of the community to the total geographic variation in the utilization of ANC services increased more than four times during the study period. The use of ANC services remains disproportionately lower among women with low socioeconomic status. Efforts to directly target these women are necessary to tackle inequality in ANC utilization in India.

Background : Antenatal care, the care that a woman receives during pregnancy, helps to ensure healthy outcomes for mother and newborns. Utilization of antenatal care services is the basic component of maternal care on which the life of mothers and babies depend.Objectives : To find out the utilization of antenatal care services in a selected rural area in Bangladesh.Methodology : Descriptive cross-sectional study was conducted between January to June 2014’ A total 199 married women of reproductive age who had a live baby below 5years of age, were selected purposively from village Islampur in Dhamrai Upzilla under Dhaka district. Data were collected by face to face interview using a pre-tested structured questionnaire.Result : The study revealed that 94.97% utilized ANC services among them 44.72% visited for ANC more than 4 times, 20.10% for 4 times and 30.15% less than 4 times during pregnancy. Health care centre was within walking distance. Most of them were young women aged between 23-27 years (45.72%) and 18-22 years (36.18%). Majority (33.16%) was educated up to secondary level but 83.42% were house wife. Economic status was lower economic group. Half of the respondents (52%) took ANC on their own and permission of husband and 95.97% received special care from their family during pregnancy. For birth planning 86.83% planned health provider to conduct delivery and 71.36% wanted hospital delivery. Majority (97.98%) took birth preparedness during pregnancy and 55% received antenatal care from qualified doctor. About 87% found them available on duty and good behavior was found by 70.90% respondents. Information about danger signs during pregnancy were received by 77.89% of the respondents.Conclusion : Utilization of Antenatal care service was higher in the study area. Most of the mothers had idea about benefit of ANC. Mother's education, family support, behaviour, availability of health care service provider and distance of health centre influence higher utilization. Therefore, to strengthen and intensify the ANC service at all level of health care delivery throughout the country is necessary for sustainability and targeting suboptimum ANC utilization group.Northern International Medical College Journal Vol.6(1) 2014: 25-28

In sub-Saharan Africa, improving equitable access to healthcare remains a major challenge for public health systems. Health policymakers encourage the adoption of health insurance schemes to promote universal healthcare. Nonetheless, progress towards this goal remains suboptimal due to inequalities health insurance ownership especially among women. In this study, we aimed to explore the sociodemographic factors contributing to health insurance ownership among women in selected francophone countries in sub-Saharan Africa. Methods. This study is based on cross-sectional data obtained from Demographic and Health Surveys on five countries including Benin (n = 13,407), Madagascar (n = 12,448), Mali (n = 10,326), Niger (n = 12,558), and Togo (n = 6,979). The explanatory factors included participant age, marital status, type of residency, education, household wealth quantile, employment stats, and access to electronic media. Associations between health insurance ownership and the explanatory factors were analyzed using multivariate regression analysis, and effect sizes were reported in terms in average marginal effects (AMEs). Results. The highest percentage of insurance ownership was observed for Togo (3.31%), followed by Madagascar (2.23%) and Mali (2.2%). After stratifying by place of residency, the percentages were found to be significantly lower in the rural areas for all countries, with the most noticeable difference observed for Niger (7.73% in urban vs. 0.54% in rural women). Higher levels of education and wealth quantile were positively associated with insurance ownership in all five countries. In the pooled sample, women in the higher education category had higher likelihood of having an insurance: Benin (AME = 1.18; 95% CI = 1.10, 1.27), Madagascar (AME = 1.10; 95% CI = 1.05, 1.15), Mali (AME = 1.14; 95% CI = 1.04, 1.24), Niger (AME = 1.13; 95% CI = 1.07, 1.21), and Togo (AME = 1.17; 95% CI = 1.09, 1.26). Regarding wealth status, women from the households in the highest wealth quantile had 4% higher likelihood of having insurance in Benin and Mali and 6% higher likelihood in Madagascar and Togo. Conclusions. Percentage of women who reported having health insurance was noticeably low in all five countries. As indicated by the multivariate analyses, the actual situation is likely to be even worse due to significant socioeconomic inequalities in the distribution of women having an insurance plan. Increasing women's access to healthcare is an urgent priority for population health promotion in these countries, and therefore, addressing the entrenched sociodemographic disparities should be given urgent policy attention in an effort to strengthen universal healthcare-related goals.

BackgroundComplications of pregnancy and childbirth are a leading cause of maternal morbidities and mortalities in developing countries. World Health Organization (WHO) estimates that over 500,000 women and girls die each year from the complications. Despite proven interventions that could prevent death or disability during pregnancy and childbirth, maternal mortality remains a major burden in many developing countries, including Ethiopia. This study aimed to assess the status of antenatal care utilization and modeling Bayesian Count Regression model for the determinants of utilization of antenatal care services visits among pregnant women in Amhara regional state.MethodsIt was a community based analytical cross-sectional study, conducted in Amhara region among women in the reproductive age group (age 15–49). The analysis was based on data from women who had at least one birth during the 5 years preceding the survey. The source of data was the 2014 Ethiopia Demographic and Health Survey which was accessed from Central Statistical Agency. Bayesian analytic approach was applied to model the mixture data structure inherent in zero-inflated count data by using the zero-inflated Poisson model.ResultsAbout 37% (95% CI 0.32, 0.42) of the pregnant mothers were not received antenatal care services during their pregnancy and about 23% of them were visited at least four times. From Bayesian zero inflated Poisson regression it was found that rural pregnant women (OR = 1.13; HPD CI 1.12, 1.44), women who can read and write (OR = 0.54; HPD CI 0.40, 0.72), middle Wealth index (OR = 0.60; HPD CI 0.46, 0.78) and media exposures (OR = 0.72; HPD: 0.56, 0.92) were statistically associated with no ANC visits.ConclusionsAbout three-fourth pregnant mothers were not receive adequate number of visits recommended by the World Health Organization. Mother’s education, media exposure, residence and wealth index were significant predictors of ANC service utilization. This research suggests that to reduce the inadequate number of ANC visits in Amhara region, attention should be given to women with low educational status and rural women.

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Access to adequate health services remains a global challenge, especially in rural and remote areas. Health insurance ownership has emerged as a solution to increase the utilization of health services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives:&lt;/strong&gt; This study aimed to explore the role of health insurance ownership in increasing the utilization of primary health services in rural highland areas in Indonesia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This research used a quantitative design with a cross-sectional survey method. The study population consisted of 728 adult individuals who were heads of households living in Kanreapia Village, Tinggi Moncong District, Gowa Regency, South Sulawesi. The sampling technique used purposive sampling. Data were collected through interviews with a structured questionnaire, including demographic variables, health insurance ownership status, and utilization of health services. Data analysis used descriptive statistics, chi-square tests, and logistic regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The results showed a significant relationship between demographic variables, health insurance ownership, and the utilization of health services. Individuals with health insurance were 6.764 times more likely to utilize health services compared to those without insurance (p&amp;lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; This study strengthens the evidence that health insurance ownership significantly increases an individual's likelihood of utilizing health services, especially in relatively isolated rural areas.&lt;/p&gt;

Long-Term Trend in Inequalities by Socioeconomic Status and Residence Type and Geographic Variation in the Utilization of Antenatal Care Service in India: Result from the National Family Health Survey 1998-2015

Background: Access to Sexual and Reproductive Health (SRH) services remains a significant public health challenge, particularly in rural and underserved areas. The Health Bazaar initiative was introduced as a community-based intervention to improve SRH service utilization and family planning uptake among reproductive-age women in Ethiopia. This study evaluates the effectiveness of the Health Bazaar model in improving access to SRH services, institutional delivery, antenatal care (ANC), postnatal care (PNC), and contraceptive utilization in intervention (Health Bazaar) compared to non-intervention areas (running SRH services in the routine health system). Methods: A comparative cross-sectional study was conducted in five Ethiopian regions where the Health Bazaar model was implemented. Data were collected from 1,284 reproductive-age women (15–49 years), equally distributed between intervention (n=642) and non-intervention (n=642) areas. Additionally, secondary data from the District Health Information System (DHIS2) (2018–2024) were analysed to assess trends in SRH service utilization. A multistage cluster sampling approach was used, and data were analysed using descriptive statistics, trend analysis, and multilevel mixed-effects logistic regression to identify factors associated with SRH service uptake. Results: The study found that SRH service utilization was significantly higher in intervention areas (65.1%) compared to non-intervention areas (47.6%) (p &lt; 0.001). Contraceptive prevalence was also higher in intervention areas (53.3% vs. 41.8%, p = 0.001), with injectables (45.8%) and implants (44.5%) being the most commonly used methods. ANC service utilization was higher in intervention areas (87.3%) compared to non-intervention areas (77.1%), and institutional delivery rates were 89.4% in intervention areas compared to 80.6% in non-intervention areas. Trend analysis showed a greater increase in ANC (10.2 per quarter), institutional deliveries (5.8 per quarter), and PNC utilization (9.5 per quarter) in intervention areas compared to non-intervention areas. These differences remained statistically significant after adjusting for potential confounding factors, including age, marital status, education, household income, region, and participation in SRH-related discussions. Conclusion: The study findings demonstrate that the Health Bazaar intervention significantly improved SRH service utilization, family planning uptake, and maternal health service access in Ethiopia. The community-driven model holds potential for scaling up to further enhance SRH services in similar low-resource settings. Future interventions should focus on addressing remaining barriers such as awareness gaps, distance to health facilities, and socio-cultural influences to maximize impact.

BackgroundIn developing countries a large number of women are dying due to factors related to pregnancy and child birth. Implementing and assuring utilization of maternal health care services is potentially one of the most effective health interventions for preventing maternal morbidity and mortality. However, in Ethiopia the utilization of maternal health care is low.MethodsA cross-sectional study was conducted from January 20 to February 20, 2012 in Holeta town, central Ethiopia, to assess the determinants of maternal health care utilization among women who had given birth in the past three years prior to the survey. Structured questionnaire and focus group discussion guides were used for data collection. Data were collected from a sample of 422 women in the town. Descriptive, bivariate and multivariate logistic regression analyses were conducted. Statistical tests were done at a level of significance of p < 0.05.ResultsThe study revealed that 87% of the women had at least one antenatal visit during their last pregnancy. Among the antenatal service users, 33.7% had less than four antenatal visits. More than half of the antenatal care (ANC) attendants made their first visit during their second and third trimester of pregnancy although WHO recommended ANC should be started at the first trimester of the pregnancy. There was a significant association (P<0.05) between ANC attendance and some demographic, socio-economic and health related factors (age at last birth, literacy status of women, average monthly family income, media exposure, attitude towards pregnancy, knowledge on danger signs of pregnancy and presence of husband approval on ANC). The study also revealed that about 61.6% of the women had given birth in the health institutions. Parity, literacy status of women, average monthly family income, media exposure, decision where to give birth, perception of distance to health institutions (HI) and ANC attendance were found to be significantly associated (P<0.05) with delivery care (DC) attendance.ConclusionsThe utilization of ANC and DC service is inadequate in the town. The utilization of ANC and DC were influenced by demographic, socio-economic and health related factors. Improving the status of women by expanding educational opportunities, strengthening promotion of antenatal and delivery care by enhancing community awareness about the importance of ANC and DC are recommended.

BackgroundEthiopia is one of the sub-Saharan African country with high maternal mortality ratio (MMR). According to Ethiopian demographic health survey (EDHS) 2016 report, MMR is 420 among 100,000 live births. Antenatal care utilization is a key intervention to reduce these deaths through problem detection and treatment, promotion of health seeking behavior, and preparing pregnant women for birth. Therefore, this study aimed to assess prevalence and factors associated with antenatal care service utilization in Ethiopia in 2016.MethodsSecondary data analysis was done on EDHS 2016. It was a stratified, two-stage, and cluster sampling design. Analysis has been restricted to antenatal care utilization among women who delivered at least one time in the past five years. Data were weighted to correct sampling bias. Moreover, complex data analysis was done. Bi-variate and multivariable logistic regression analyses were carried out. Adjusted odds ratio with 95% confidence interval was computed and P-value less than 0.05 considered as a statistically significance level for identification of association.ResultsPrevalence of antenatal care utilization was 62.8% [95%CI: 60.9, 64.6] in this study. Maternal educational status of primary school (AOR = 1.8,95%CI:1.2, 2.6), maternal educational status of secondary school (AOR = 4.4,95%CI: 1.1, 17.3), women who listen radio less than 1 per week (AOR = 1.9,95%CI:1.12,3.34), women who listen radio at least 1 per week (AOR = 2.6,95%CI:1.4,4.8), women in rich wealth quintile (AOR = 1.9,95%CI: 1.1, 3.2) were factors positively associated with antenatal care utilization. However, women who had traditional belief (AOR = 0.1,95%CI:0.02,0.49), and women who had five children and above (AOR = 0.6,95%CI: 0.3, 0.9) were factors associated negatively with antenatal care utilization.ConclusionsPrevalence of antenatal care utilization is still low in Ethiopia in 2016. Maternal higher maternal educational status, frequent radio listening, higher wealth quintile, traditional belief, and greater number of children were found to be associated significantly with antenatal care utilization. Consequently, socio-economic status should be enhanced, information should be accessed by women about antenatal care utilization and family planning service through mass media. Furthermore, intensive community education program should be designed for traditional believers to increase uptake of antenatal care by stakeholders.

Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O’Malley’s methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural–urban disparity, and women’s literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.