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“Well, not me, but other women do not register because...”- Barriers to seeking antenatal care in the context of prevention of mother-to-child transmission of HIV among Zimbabwean women: a mixed-methods study

Sibanda, Euphemia, Bernays, Sarah, Weller, Ian V. D., Hakim, James G. and Cowan, Frances (2018) '“Well, not me, but other women do not register because...”- Barriers to seeking antenatal care in the context of prevention of mother-to-child transmission of HIV among Zimbabwean women: a mixed-methods study'. BMC Pregnancy and Childbirth, Vol 18, Issue 1.

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Abstract

Background: While barriers to uptake of antenatal care (ANC) among pregnant women have been explored, much
less is known about how integrating prevention of mother-to-child transmission (PMTCT) programmes within ANC
services affects uptake. We explored barriers to uptake of integrated ANC services in a poor Zimbabwean
community.
Methods: A cross-sectional survey was conducted among post-natal women at Mbare Clinic, Harare, between
September 2010 and February 2011. Collected data included participant characteristics and ANC uptake. Logistic
regression was conducted to determine factors associated with ANC registration. In-depth interviews were held
with the first 21 survey participants who either did not register or registered after twenty-four weeks gestation to
explore barriers. Interviews were analysed thematically.
Results: Two hundred and ninety-nine participants (mean age 26.1 years) were surveyed. They came from ultra-poor
households, with mean household income of US$181. Only 229 (76.6%) had registered for ANC, at a mean gestation of
29.5 weeks. In multivariable analysis, household income was positively associated with ANC registration, odds ratio (OR)
for a $10-increase in household income 1.02 (95% confidence interval, CI, 1.0–1.04), as was education which interacted
with having planned the pregnancy (OR for planned pregnancy with completed ordinary level education 3.27 (95%CI 1.
55–6.70). Divorced women were less likely to register than married women, OR 0.20 (95%CI 0.07–0.58). In the qualitative
study, barriers to either ANC or PMTCT services limited uptake of integrated services. Women understood the importance
of integrated services for PMTCT purposes and theirs and the babies’ health and appeared unable to admit to barriers
which they deemed “stupid/irresponsible”, namely fear of HIV testing and disrespectful treatment by nurses. They
represented these commonly recurring barriers as challenges that “other women” faced. The major proffered personal
barrier was unaffordability of user fees, which was sometimes compounded by unsupportive husbands who were the
breadwinners.
Conclusion: Women who delayed/did not register were aware of the importance of ANC and PMTCT but were either
unable to afford or afraid to register. Addressing the identified challenges will not only be important for integrated
PMTCT/ANC services but will also provide a model for dealing with challenges as countries scale up ‘treat all’ approaches.
Keywords: Antenatal care; PMTCT, Qualitative study, User fees, HIV testing

Item Type: Article
Subjects: QS Anatomy > QS 4 General works. Classify here works on regional anatomy
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > WA 55 Registration of notifiable diseases
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WQ Obstetrics > Pregnancy Complications > WQ 256 Infectious diseases
WS Pediatrics > WS 100 General works
WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology
WS Pediatrics > By Age Groups > WS 421 Diseases of newborn infants
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12884-018-1898-7
Depositing User: Stacy Murtagh
Date Deposited: 10 Jul 2018 10:00
Last Modified: 10 Jul 2018 10:00
URI: http://archive.lstmed.ac.uk/id/eprint/8892

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