The tipping point of antenatal engagement: a qualitative grounded theory in Tanzania and Zambia

Laisser, Rose, Wood, Rebecca, Bedwell, Carol, Kasengele, Chowa, Nsemwa, Livuka, Kimaro, Deborah, Kuzenza, Flora, Lyangenda, Kutemba, Shayo, Happiness, Tuwele, Khuzuet, Wakasiaka, Sabina, Ringia, Prisca and Lavender, Tina (2022) 'The tipping point of antenatal engagement: a qualitative grounded theory in Tanzania and Zambia'. Sexual & Reproductive Healthcare, Vol 31, Issue 100673.

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Abstract

Background
Effective antenatal care is fundamental to the promotion of positive maternal and new-born outcomes. International guidance recommends an initial visit in the first trimester of pregnancy, with a minimum of four antenatal visits in total: the optimum schedule being eight antenatal contacts. In low- and middle-income countries, many women do not access antenatal care until later in pregnancy and few have the recommended number of contacts.

Aim
To gain understanding of women’s antenatal experiences in Tanzania and Zambia, and the factors that influence antenatal engagement.

Methods
The study was underpinned by Strauss’s grounded theory methodology. Interviews were conducted with 48 women, 16 partners, 21 health care providers and 11 stakeholders, and analysed using constant comparison.

Findings
The core category was ‘The tipping point of antenatal engagement’, supported by four categories: awareness of health benefits, experiential motivators, influential support, and environmental challenges. Although participants recognised the importance of antenatal care to health outcomes, individual motivations and external influences determined attendance or non-attendance. The ‘tipping point’ for antenatal engagement occurred when women believed that any negative impact could be offset by tangible gain. For some women non-attendance was a conscious decision, for others it was an unchallenged cultural norm.

Conclusion
A complex interplay of factors determines antenatal engagement. Short-term modifiable factors to encourage attendance include the development of strategies for increasing respectful care; use of positive women’s narratives, and active community engagement. Further research is required to develop innovative, cost-effective care models that improve health literacy and meet women’s needs.

Item Type:	Article
Subjects:	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 WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1016/j.srhc.2021.100673
Depositing User:	Rachel Dominguez
Date Deposited:	11 Nov 2021 12:44
Last Modified:	11 Nov 2021 12:44
URI:	https://archive.lstmed.ac.uk/id/eprint/19243

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