Antenatal care in Nepal: a qualitative study into missed opportunities in the first trimester

Felicity Greenfield; Mary Lynch; Nashna Maharjan; Miriam Toolan; Katie Barnard; Tina Lavender; Michael Larkin; Nisha Rai; Meena Thapa; Deborah M. Caldwell; Christy Burden; Dharma S. Manandhar; Abi Merriel

doi:10.1016/j.xagr.2022.100127

Antenatal care in Nepal: a qualitative study into missed opportunities in the first trimester

Felicity Greenfield
, Mary Lynch
, Nashna Maharjan
, Miriam Toolan
, Katie Barnard
, Tina Lavender
, Michael Larkin
, Nisha Rai
, Meena Thapa
, Deborah M. Caldwell
, Christy Burden
, Dharma S. Manandhar
, Abi Merriel^*

^*Corresponding author for this work

Bristol Medical School, University of Bristol, Bristol, United Kingdom (Ms Greenfield)
Academic Women's Health Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom (Ms Lynch and Barnard, Drs Toolan, Burden and Merriel); North Bristol NHS Trust, Bristol, United Kingdom (Ms Lynch, Barnard)
Mother and Infant Research Activities (MIRA), Department of Clinical Science Kathmandu, Nepal (Ms Maharjan and Dr Manandhar)
Academic Women's Health Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom (Ms Lynch and Barnard, Drs Toolan, Burden and Merriel); National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol, United Kingdom (Drs Burden, Toolan)
Liverpool School of Tropical Medicine, Liverpool, United Kingdom (Dr Lavender)
Department of Gynaecology and Obstetrics, Hetauda Hospital, Hetauda, Nepal (Dr Rai)
Kathmandu Medical College, Kathmandu, Nepal (Dr Thapa)
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (Dr Caldwell)
Academic Women's Health Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom (Ms Lynch and Barnard, Drs Toolan, Burden and Merriel); Centre for Women's Health Research, Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool Women's Hospital, Liverpool, United Kingdom (Dr Merriel)

Research output: Contribution to journal › Article › peer-review

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Abstract

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.

Original language	English
Article number	100127
Journal	AJOG Global Reports
Volume	2
Issue number	4
Early online date	4 Nov 2022
DOIs	https://doi.org/10.1016/j.xagr.2022.100127
Publication status	Published - 30 Nov 2022

Bibliographical note

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

focus groups
folic acid
low-income countries
pregnancy care
South Asia
ultrasound scanning

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10.1016/j.xagr.2022.100127Licence: CC BY 4.0

1-s2.0-S2666577822000752-main
© 2022 The Authors. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Final published version, 468 KBLicence: CC BY 4.0

Cite this

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title = "Antenatal care in Nepal: a qualitative study into missed opportunities in the first trimester",

abstract = "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.",

keywords = "focus groups, folic acid, low-income countries, pregnancy care, South Asia, ultrasound scanning",

author = "Felicity Greenfield and Mary Lynch and Nashna Maharjan and Miriam Toolan and Katie Barnard and Tina Lavender and Michael Larkin and Nisha Rai and Meena Thapa and Caldwell, \{Deborah M.\} and Christy Burden and Manandhar, \{Dharma S.\} and Abi Merriel",

note = "{\textcopyright} 2022 The Authors. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). ",

year = "2022",

month = nov,

day = "30",

doi = "10.1016/j.xagr.2022.100127",

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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

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

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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 -

Antenatal care in Nepal: a qualitative study into missed opportunities in the first trimester

Abstract

Bibliographical note

UN SDGs

Keywords

Access to Document

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