Determinants of late initiation of Antenal Care among expectant Mothers in Kanyama Township, Lusaka, Zambia

Abstract

Background:Late initiation of ANC in Zambia is still a big challenge. The 2007 Zambia Demographic Health survey (ZDHS) indicates that, only 19% of mothers have had their ANC visit in the first trimester of pregnancy. The study aimed at determining factors that contribute to the delay in initiating antenatal care among expectant mothers in Kanyama Township in Lusaka.

Methods: This study was guided by Andersen’s Health Seeking Behavioral Model. A cross sectional mixed study design was done drawing from a population of expectant mothers who booked late after 16 weeks of gestation. The study used random sampling method for quantitative and the theoretical purposive sampling method, that took a maximum variation strategy for qualitative method. Data collection tools were documentary review, survey questionnaires, observations and focus group discussions. Epi-data was used to store data that was collected by survey questionnaires and after that was analyzed using Stata version 13 while data collected using Focus Group Discussions was transcribed and imported into N Vivo version 10 for analysis. Results: Social economic status such as low levels of incomes; p value 0.000 (95%CI-623, -197) and lack of proper clothes to wear for ANC; p value 0.036 (95%CI-016, -471), systemic barriers such as congestions and shortages of staff, competing matters such as demand by the health institution for expectant mothers to go with partners (spouses) for antenatal, traditional beliefs and misconception such as waiting until the pregnancy is advanced or pregnant mother start feeling foetal movement in order to motivate the husband to prepare for material needs for antenatal care, and the idea of not wanting to disclose the pregnancy when it is small for fear of losing the pregnancy were factors responsible for late booking. Conclusion: We found contextual factors such as low social economic position of most women, congestion and shortages of staff at the only health facility that offer antenatal book are constraining. The misconceptions of waiting until pregnancy is advanced or feeling of foetal movement are wrong attitudes and as such delay in antenatal care could bring serious complications. The idea of waiting for the husband to prepare for material needs for antenatal is also a traditional cultural practice that reveals how a woman is still socially and economically dependent on the spouse. Educational programs are needed in the community to reduce the existing traditional cultural practices, beliefs and misconceptions in order to initiate antenatal care early. Empowerments of women through income generative activities are needed in order to reduce much dependence of male partners. There is also need to increase staffing at Kanyama health centre especially at the maternal and child health by the government and decongest the health centre by constructing other health centers in selected prime locations to provide antenatal booking service that is still centralized.