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Qualitative exploration of facilitating factors and barriers to use of antenatal care services by pregnant women in urban and rural settings in Pakistan

BACKGROUND: World Health Organisation recommends that pregnant women with no complications should visit a healthcare provider at least four times to receive sufficient antenatal care services. In Pakistan only 37 % of women reported to have had four or more antenatal care visits during their last pr...

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Autores principales: Nisar, Yasir Bin, Aurangzeb, Brekhna, Dibley, Michael J, Alam, Ashraful
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772650/
https://www.ncbi.nlm.nih.gov/pubmed/26931205
http://dx.doi.org/10.1186/s12884-016-0829-8
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author Nisar, Yasir Bin
Aurangzeb, Brekhna
Dibley, Michael J
Alam, Ashraful
author_facet Nisar, Yasir Bin
Aurangzeb, Brekhna
Dibley, Michael J
Alam, Ashraful
author_sort Nisar, Yasir Bin
collection PubMed
description BACKGROUND: World Health Organisation recommends that pregnant women with no complications should visit a healthcare provider at least four times to receive sufficient antenatal care services. In Pakistan only 37 % of women reported to have had four or more antenatal care visits during their last pregnancy. This study aimed to explore facilitators and barriers to use of antenatal care services in rural and urban communities of two selected districts in Pakistan. METHODS: Qualitative explorative study using in-depth interviews with currently pregnant women, lady health workers and doctors providing antenatal care services, and focus group discussion with women who had a child aged 5 years or younger, was conducted in a rural community in the district Swabi and in a tertiary care hospital in urban Islamabad in Pakistan. The audio-recorded interviews and discussions were transcribed verbatim in Urdu (the language spoken by the respondents). A list of topical codes for all topics related to the research questions was developed. Subsequently the text pertaining to each topical code was discussed and summarised in a document that presented the findings for each topic using quotes and tables. RESULTS: We conducted in-depth interviews with six lady health workers, four doctors, and ten currently pregnant women, and facilitated ten focus group discussions with women who had a child aged 5 years or younger. Currently pregnant women, and women who had a child aged 5 years or younger, were not aware of the recommended minimum number of antenatal care visits to be made during pregnancy. Facilitating factors to visit a particular health care facility were: availability of qualified healthcare providers (private facility); trust in healthcare providers; recommendation from a family member, friend or lady health worker (in rural areas); availability of good quality services including medical equipment and laboratory facilities; low cost (public facility); and easy access to the health facility (private facility). Common barriers to visiting a health facility for antenatal care services were: financial limitations; perceived absence of any major health problems during pregnancy; difficulties in reaching the health facility; restriction from husband or mother-in-law; busy performing household chores; no previous experience of antenatal care visits; and perceived unavailability of healthcare providers and/or services. CONCLUSIONS: The current study identified several policy-relevant facilitating factors and barriers to visiting a health facility for antenatal care services as reported by urban and rural women, and healthcare providers. There is a need to formulate and implement intervention packages based on these findings to increase the coverage of the recommended four antenatal care visits in Pakistan. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-0829-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-47726502016-03-02 Qualitative exploration of facilitating factors and barriers to use of antenatal care services by pregnant women in urban and rural settings in Pakistan Nisar, Yasir Bin Aurangzeb, Brekhna Dibley, Michael J Alam, Ashraful BMC Pregnancy Childbirth Research Article BACKGROUND: World Health Organisation recommends that pregnant women with no complications should visit a healthcare provider at least four times to receive sufficient antenatal care services. In Pakistan only 37 % of women reported to have had four or more antenatal care visits during their last pregnancy. This study aimed to explore facilitators and barriers to use of antenatal care services in rural and urban communities of two selected districts in Pakistan. METHODS: Qualitative explorative study using in-depth interviews with currently pregnant women, lady health workers and doctors providing antenatal care services, and focus group discussion with women who had a child aged 5 years or younger, was conducted in a rural community in the district Swabi and in a tertiary care hospital in urban Islamabad in Pakistan. The audio-recorded interviews and discussions were transcribed verbatim in Urdu (the language spoken by the respondents). A list of topical codes for all topics related to the research questions was developed. Subsequently the text pertaining to each topical code was discussed and summarised in a document that presented the findings for each topic using quotes and tables. RESULTS: We conducted in-depth interviews with six lady health workers, four doctors, and ten currently pregnant women, and facilitated ten focus group discussions with women who had a child aged 5 years or younger. Currently pregnant women, and women who had a child aged 5 years or younger, were not aware of the recommended minimum number of antenatal care visits to be made during pregnancy. Facilitating factors to visit a particular health care facility were: availability of qualified healthcare providers (private facility); trust in healthcare providers; recommendation from a family member, friend or lady health worker (in rural areas); availability of good quality services including medical equipment and laboratory facilities; low cost (public facility); and easy access to the health facility (private facility). Common barriers to visiting a health facility for antenatal care services were: financial limitations; perceived absence of any major health problems during pregnancy; difficulties in reaching the health facility; restriction from husband or mother-in-law; busy performing household chores; no previous experience of antenatal care visits; and perceived unavailability of healthcare providers and/or services. CONCLUSIONS: The current study identified several policy-relevant facilitating factors and barriers to visiting a health facility for antenatal care services as reported by urban and rural women, and healthcare providers. There is a need to formulate and implement intervention packages based on these findings to increase the coverage of the recommended four antenatal care visits in Pakistan. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-0829-8) contains supplementary material, which is available to authorized users. BioMed Central 2016-03-01 /pmc/articles/PMC4772650/ /pubmed/26931205 http://dx.doi.org/10.1186/s12884-016-0829-8 Text en © Nisar et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Nisar, Yasir Bin
Aurangzeb, Brekhna
Dibley, Michael J
Alam, Ashraful
Qualitative exploration of facilitating factors and barriers to use of antenatal care services by pregnant women in urban and rural settings in Pakistan
title Qualitative exploration of facilitating factors and barriers to use of antenatal care services by pregnant women in urban and rural settings in Pakistan
title_full Qualitative exploration of facilitating factors and barriers to use of antenatal care services by pregnant women in urban and rural settings in Pakistan
title_fullStr Qualitative exploration of facilitating factors and barriers to use of antenatal care services by pregnant women in urban and rural settings in Pakistan
title_full_unstemmed Qualitative exploration of facilitating factors and barriers to use of antenatal care services by pregnant women in urban and rural settings in Pakistan
title_short Qualitative exploration of facilitating factors and barriers to use of antenatal care services by pregnant women in urban and rural settings in Pakistan
title_sort qualitative exploration of facilitating factors and barriers to use of antenatal care services by pregnant women in urban and rural settings in pakistan
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772650/
https://www.ncbi.nlm.nih.gov/pubmed/26931205
http://dx.doi.org/10.1186/s12884-016-0829-8
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