Evolution and Determinants of Antenatal Care Services Utilization Among Women in Rwanda: a Rapid Review

Abstract

Background: Maternal and child health remains a global priority, with antenatal care (ANC) recognized as essential for ensuring positive pregnancy outcomes. Despite significant improvements, ANC utilization in low and middle-income countries, particularly in Sub-Saharan Africa, remains low, contributing to high maternal and neonatal mortality rates. This paper highlighted significant progress in Rwanda's maternal health services since 2000. It further explored the evolution of ANC utilization in Rwanda, identifying key determinants and trends over the past two decades. Methods: Following a traditional maternal and child health services contextualization in Rwanda, a rapid review was conducted, searching databases such as PubMed, Google Scholar, and Scopus, alongside grey literature and reference lists. The review focused on studies published between 2010 and 2024, examining factors associated with ANC utilization in Rwanda. The screening was independently conducted by two reviewers with the assistance Rayyan application, followed by full-text screening and data synthesis. The results were presented using the forest plots to display the significant odd ratios of ANC services utilization across different predictor variables. Results: The review included 11 studies and 1 report revealing a significant improvement in ANC utilization in Rwanda. By 2019-2020, 47% of women received ANC in the first trimester, and 59% had four or more visits, compared to 35% and 38%, respectively, in 2010. Factors positively associated with adequate ANC included higher education levels, better wealth status, health insurance coverage, and small household size. Conversely, significant distance to health facilities and unwanted pregnancies were associated with lower odds of adequate ANC utilization. Delayed ANC was more likely among women with higher parity, those who lack social support, and those with no or only primary education. Conclusion: The findings indicate that Rwanda has made considerable strides in improving ANC utilization. Addressing barriers such as distance to healthcare facilities, education, and economic disparities is crucial for further enhancing maternal and child health outcomes. The review underscores the need for targeted interventions to achieve WHO recommendations of 8 ANC visits and Sustainable Development Goals (SDGs) related to maternal and child health in Rwanda.