Document Type
Article
Department
School of Nursing and Midwifery, Pakistan
Abstract
Background: Antenatal care (ANC) is critical for achieving Sustainable Development Goals (SDG) 3.1 and 3.2, aiming to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, and to decrease neonatal and under-5 mortality rates. Despite its importance, approximately 830 women die daily from preventable pregnancy and childbirth causes, predominantly in low-resource settings.
Methods: The study conducted a comprehensive literature search from January 1, 2009, to December 30, 2020, focusing on delayed initiation of ANC in low- and middle-income countries (LMICs). The search used multiple databases and included observational research and Demographic and Health Survey (DHS) results, yielding 2034 findings. After applying exclusion criteria, 23 papers were selected for quality assessment and synthesis.
Results: Socioeconomic and regional disparities significantly affect ANC utilization. Studies from India, Uganda, Kenya, Myanmar, Zimbabwe, and Pakistan show varying levels of ANC service utilization. India and Myanmar reported high utilization in some areas, while regions like North India and Zimbabwe face challenges due to long distances to health facilities, lack of transportation, and inadequate health services. Factors such as education, transportation, income, and geographical location significantly impact ANC attendance. In Kenya and Somaliland, traditional birth attendants and low confidence in healthcare practitioners contribute to low ANC utilization rates. Pakistan shows moderate improvement in maternal health services utilization, yet significant challenges remain in ensuring comprehensive ANC coverage.
Conclusions: Barriers to ANC utilization in LMICs are multifaceted, including individual, community, and healthcare facility levels. Low education, cultural influences, lack of support, cost, distance, dissatisfaction with services, and inadequate staffing are major obstacles. Addressing these issues requires a holistic approach to improve accessibility, quality of care, and community awareness, ensuring that pregnant women receive the necessary healthcare services.
Recommended Citation
Johnson, J, Mansha, R, & Musaddique, A. Determinants of underutilization of maternal health services in ANC clinics in LMICs: A narrative review. Journal of Asian Midwives. 2024;11(1):98–111.
