TY - JOUR
T1 - Antenatal care in Nepal: a qualitative study into missed opportunities in the first trimester
AU - Greenfield, Felicity
AU - Lynch, Mary
AU - Maharjan, Nashna
AU - Toolan, Miriam
AU - Barnard, Katie
AU - Lavender, Tina
AU - Larkin, Michael
AU - Rai, Nisha
AU - Thapa, Meena
AU - Caldwell, Deborah M.
AU - Burden, Christy
AU - Manandhar, Dharma S.
AU - Merriel, Abi
N1 - © 2022 The Authors. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
PY - 2022/11/30
Y1 - 2022/11/30
N2 - BACKGROUND
Use of timely antenatal care has been identified as key to facilitating healthy pregnancies worldwide. Although considerable investment has been made to enhance maternal health services in Nepal, approximately one-third of women do not attend antenatal care until after the first trimester (late). These women miss out on the benefits of screening and interventions that are most effective in the first trimester.
OBJECTIVE
This study aimed to identify the missed opportunities of women who do not attend antenatal care in the first trimester, and to explore some of the factors underlying late attendance and consider potential solutions for minimizing these missed opportunities in the future.
STUDY DESIGN
This study was conducted in 3 hospitals in Nepal. Focus groups (n=18) with a total of 48 postnatal women and 49 staff members, and 10 individual interviews with stakeholders were conducted. Purposive sampling facilitated the obtainment of a full range of maternity experiences, staff categories, and stakeholder positions. Data were qualitative and analyzed using a thematic approach.
RESULTS
Limited awareness among women of the importance of early antenatal care was reported as a key factor behind attendance only after the first trimester. The family and community were described as significant influencers in women's decision-making regarding the timing of antenatal care. The benefits of early ultrasound scanning and effective supplementation in pregnancy were the major missed opportunities. Increasing awareness, reducing cost, and enhancing interprofessional collaboration were suggested as potential methods for improving timely initiation of antenatal care.
CONCLUSION
Limited awareness continues to drive late attendance to antenatal care after the first trimester. Investment in services in the first trimester and community health education campaigns are needed to improve this issue and enhance maternal and neonatal outcomes.
AB - BACKGROUND
Use of timely antenatal care has been identified as key to facilitating healthy pregnancies worldwide. Although considerable investment has been made to enhance maternal health services in Nepal, approximately one-third of women do not attend antenatal care until after the first trimester (late). These women miss out on the benefits of screening and interventions that are most effective in the first trimester.
OBJECTIVE
This study aimed to identify the missed opportunities of women who do not attend antenatal care in the first trimester, and to explore some of the factors underlying late attendance and consider potential solutions for minimizing these missed opportunities in the future.
STUDY DESIGN
This study was conducted in 3 hospitals in Nepal. Focus groups (n=18) with a total of 48 postnatal women and 49 staff members, and 10 individual interviews with stakeholders were conducted. Purposive sampling facilitated the obtainment of a full range of maternity experiences, staff categories, and stakeholder positions. Data were qualitative and analyzed using a thematic approach.
RESULTS
Limited awareness among women of the importance of early antenatal care was reported as a key factor behind attendance only after the first trimester. The family and community were described as significant influencers in women's decision-making regarding the timing of antenatal care. The benefits of early ultrasound scanning and effective supplementation in pregnancy were the major missed opportunities. Increasing awareness, reducing cost, and enhancing interprofessional collaboration were suggested as potential methods for improving timely initiation of antenatal care.
CONCLUSION
Limited awareness continues to drive late attendance to antenatal care after the first trimester. Investment in services in the first trimester and community health education campaigns are needed to improve this issue and enhance maternal and neonatal outcomes.
KW - focus groups
KW - folic acid
KW - low-income countries
KW - pregnancy care
KW - South Asia
KW - ultrasound scanning
UR - https://www.sciencedirect.com/science/article/pii/S2666577822000752?via%3Dihub
U2 - 10.1016/j.xagr.2022.100127
DO - 10.1016/j.xagr.2022.100127
M3 - Article
C2 - 36451897
SN - 2666-5778
VL - 2
JO - AJOG Global Reports
JF - AJOG Global Reports
IS - 4
M1 - 100127
ER -