Individual and healthcare system factors influencing antenatal care attendance in Saudi Arabia

Abstract

Background: The World Health Organisation recommends women have at least four antenatal care visits (ANC) during a low risk pregnancy. However, in Saudi Arabia, many mothers miss these appointments, placing their health and that of their baby at risk. Limited research which has explored why this is happening has focused on low maternal education or personal barriers such as lack of transport. The aim of the current research was therefore to understand what factors at the individual and healthcare systems level were associated with missing antenatal care in Saudi Arabia. Methods: Two hundred and forty-two pregnant women in their third trimester completed a questionnaire examining their care attendance (appointments missed, planned future attendance, timing of first appointment) alongside barriers to attending care. These included maternal demographic background, health literacy, personal barriers, health care system factors and staff communication). Results: Over half of women surveyed had missed at least one appointment and a third had delayed their care. Mothers who had missed or delayed appointments blamed health care system factors such as poor clinic facilities and waiting times. Attending care was not associated with maternal education or literacy, although mothers with a lower level of literacy were more likely to delay care. However, perceptions of staff communication, consistency and care were lower amongst mothers who had missed at least one appointment. Conclusions: Although in previous research health professionals believe it is maternal education that leads to poor attendance, in our sample at least, perceptions of staff communication and clinic facilities were instead associated with attendance. Making changes at the health care level e.g. through adapting clinic times and investing in staff training may increase antenatal care attendance in Saudi Arabia.

<p>Inadequate and Late Antenatal Contacts Among Saudi Mothers: A Hospital-Based Cross-Sectional Study</p>

“…A study in the Riyadh region of Saudi Arabia found that around 48% of women missed one or more appointments. 18 We found that employment and high parity were independently associated with inadequate antenatal contacts. The association between employment and inadequate antenatal contacts is consistent with a previous study in Saudi Arabia, 10 and Kenya, 27 while inconsistent with study in Nigeria.…”

“…However, that study defined “late” as after 8 weeks of pregnancy, which is less than the WHO definition. 18 This could be explained by a regional variation within Saudi Arabia. A study in Oman reported that 23% have a late first antenatal contact, with regional variation ranging from 12% to 47%.…”

“…It has a population of approximately 165,000, and 17 primary healthcare centers (PHC). 23 At least eight antenatal contacts offered for uncomplicated pregnancy, 18 starting their antenatal contacts in PHCs or private clinics, and at week 36, are referred to King Saud Hospital for their seventh and eighth antenatal contacts. Some women may require additional contacts, depending on their condition.…”

“… 17 A recent study in the Riyadh region reported that 48% of women did not attend one or more antenatal contacts and 34% initiated contact late. 18 A study in Medinah region reported that 80% of women stated that they followed up their pregnancy regularly, 16% did not, and 4% did not attend at all. 19 Another study reported that most women attended their first antenatal appointment after the first trimester.…”

Hyperemesis Gravidarum in First-Trimester Pregnant Saudi Women: Is Helicobacter pylori a Risk Factor?

“…Screening, preventing, and managing infectious diseases are also part of prenatal care, as is the provision of prophylactic medication (The Partnership for Maternal Newborn and Child Health, 2011). Such prenatal care is widely available in Saudi Arabia, beginning in the first trimester, providing at least eight visits for women who have pregnancies without complications (Alanazy and Brown, 2020). This case-control study was conducted on 45 expectant women in their initial 3 months of pregnancy presenting with HG at King Abdulaziz University (KAU) Hospital of Gynecology and Obstetrics (a tertiary hospital), Jeddah, Saudi Arabia, from January 2017 to May 2017 and compared them with the same number of healthy pregnant women as a control group.…”