Maternal Antenatal Care Access and Attendance: A Qualitative Study of Midwives’ and Pregnant Women’s Experiences in Kilifi, Kenya

Maina, Rose

Abstract

Background: Antenatal care (ANC) protects against maternal morbidity and mortality.
Maternal mortality remains unacceptably high in sub-Saharan African communities, which is
strongly linked to low antenatal clinic attendance. Despite substantial evidence linking ANC
with improved maternal and newborn health outcomes, inadequate access and other barriers
to service use continue to be challenges in low- and middle-income countries. Although many
factors hindering ANC attendance have been reported, the resulting evidence base has not
been effectively disseminated or translated into strategies that reduce maternal mortality.
Study aim: This research explored the experiences of ANC access and attendance from the
perspectives of midwives and pregnant women to understand their temporal decision-making
around help-seeking during the antenatal period.
Research method: A qualitative descriptive research approach was used to explore ANC
access and attendance from midwives’ and women’s perspectives. Individual semi-structured
interviews were used to capture midwives and pregnant women’s experiences in accessing
ANC. Data for this study were collected from a purposeful sample comprising 10 midwives
providing care in the ANC unit, and 20 mothers receiving routine ANC or admitted in the
acute care setting in Kilifi County hospitals. The data was collected through semi-structured
interviews between May and September 2021. The interviews were transcribed verbatim and
analysed to identify themes using content analysis. A minimal inference approach was used
to guide the formation of key themes, which drew on the generic model of patient care
developed by Betty Neuman.
Results: The key findings from this study showed that women wanted to utilize ANC, but there
were many barriers that deterred them from ANC access and attendance. Three main themes
emerged: individual factors and perceptions; sociocultural and economic influences; and
system and structural factors related to ANC access and attendance. The results suggested that
ANC remains underused in Kenya and is associated with maternal deaths. Three distinct
contributing factors reported by midwives were related to workload pressure: i) the number of
patients that needed to be seen per day; ii) the referral of difficult cases to the clinic from other
health services; and iii) the management of women’s complaints about waiting times.
Participating midwives also expressed concern that women attended ANC late and only when
in need. Participants’ narratives suggested that strategies such as improving male involvement
and community education may help to improve ANC attendance.
Conclusions: Decision-making during pregnancy is a critical factor in shaping pregnant
women’s autonomy and temporality but is challenged by complex factors. In this study, both
midwives and mothers revealed a number of temporal considerations that either delayed,
hindered or resulted in less-than-optimal ANC attendance. These findings present a valuable
framework for further research, offering insights that can inform midwives in devising
effective strategies to address barriers related to ANC access and attendance. Addressing
factors that hinder ANC attendance has the potential to significantly positively impact
maternal mortality rates in this context.

Citation

Maina, R. (2024). Maternal Antenatal Care Access and Attendance: A Qualitative Study of Midwives’ and Pregnant Women’s Experiences in Kilifi, Kenya. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Jan 19, 2024
• Publicly Available Date: Feb 27, 2024
• Award Date: Jan 26, 2024