Perceived barriers to utilization of antenatal care services in northern Uganda: A qualitative study

Abstract

Objective: Antenatal care (ANC) utilization remains a challenge in efforts to reduce maternal mortality and improve maternal health in Uganda. This study aimed to identify perceived barriers to utilization of ANC services in a rural post-conflict area in northern Uganda. Methods: A qualitative study using in-depth interviews and focus group discussions of seventeen participants (pregnant women, health workers and a traditional birth attendant). The study was informed through a phenomenological approach to capture perceived barriers to utilization of ANC. The study was carried out in post-conflict Awach sub-county, Gulu District, northern Uganda. Data was analyzed using inductive conventional content analysis. Results: The main perceived barriers to ANC utilization were identified as: poor quality of care including poor attitude of health workers; socio-cultural practices not being successfully aligned to ANC; and lack of support from the husband including difficulties in encouraging him to attend ANC. Additionally, institutional structures and procedures at the health centers in terms of compulsory HIV testing and material requirements and transportation were perceived to prevent some pregnant women from attending ANC. Conclusions: Identifying local barriers to ANC utilization are important and should be considered when planning ANC programs. We propose that future efforts should focus on how to ensure a good patient-provider relationship and perceived quality of care, and further how to improve inter-spousal communication and sensitization of husbands for increased involvement in ANC. We recommend more research on how socio-cultural context can meaningfully be aligned to ANC to improve maternal health and reduce maternal mortality.

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“…women feels that ANC is not necessary while 29% and 6.5% of the women said that they did not use the ANC services due to lack of support from husband and lack of support from health worker respectively. Similar study done by Uldbjerg C S et al, showed that the main perceived barriers to ANC utilization were identified as poor awareness among women, poor attitude of health workers, socio-cultural practices not being successfully aligned to ANC and lack of support from the husband, including difficulties in encouraging him to accompany to attend ANC [7].…”

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“…So to lower the perceived barrier, it is necessary to provide interventions in the form of health education in order to increase knowledge and awareness [31]. Culture and social environment can also be a perceived barrier for a person [32]. Intervention development programs are needed to lower the perceived barrier [33].…”

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“…Nisingizwe et al (2020) stated that perceived barriers reduced the use of antenatal care. According to Uldbjerg et al (2020), perceived barriers occurred due to lack of resources at health centers, poor attitudes of health care personnel, mismatches among ANCs, age of young or old mothers, procedures at the community health center, mandatory HIV testing and checking up. 11.…”

“…According to a study conducted by Uldbjerg et al (2020), the main barriers to the use of ANC that could be identified were unqualified services including poor behavior of health care personnel, socio-cultural practices that were not successfully harmonized with ANC, and low support from the husbands including difficulties in encouraging them to attend ANC. Poor knowledge and maternal attitudes of ANC will affect ANC visit practices.…”