23 January 2013
Researchers have examined why antenatal healthcare programs provided in low and middle-income countries* are having a limited impact on reducing death during pregnancy and childbirth.
The research, carried out by a team at the University of Central Lancashire (UCLan), was published in PLOS Medicine on January 22, 2013.
More than 800 women die every day from complications during pregnancy and child birth and 99% of these deaths occur in low-resource settings**.
Despite considerable efforts and focus on maternal and child health in low-income countries in recent years, less than half of pregnant women there attend the four antenatal visits recommended by the World Health Organisation.
To understand why antenatal programs are not more successful, UCLan’s Kenneth Finlayson and Professor Soo Downe systematically reviewed studies concerning the views and experiences of women from low and middle-income countries who had received inadequate antenatal care.
“In many of the countries we looked at there appears to be a gulf between the theories that underpin the provision of antenatal care and the beliefs and socio-economic contexts of women who access services irregularly or not at all”
Analysing 21 well-conducted studies representing over 1200 women from 15 countries, the researchers found that programs focused on pregnancy-associated risks to women’s health, whereas many women saw pregnancy as a healthy state which didn’t require the assistance of a doctor unless complications were experienced.
Some women also perceived pregnancy as ‘socially risky’ and therefore better kept as a secret rather than publicly declaring it with a visit to an antenatal clinic.
Being faced with extreme poverty or difficulties and risks associated with traveling to a clinic, women questioned whether the costs of antenatal clinic visits justified the benefits.
Commenting on the study Professor Downe, a midwifery expert in the School of Health, said: “In many of the countries we looked at there appears to be a gulf between the theories that underpin the provision of antenatal care and the beliefs and socio-economic contexts of women who access services irregularly or not at all. This could explain the lack of interest in seeking care as well as the difficulty in physically getting to antenatal clinics once interest has been established.”
“In many ways this new research mirrors what we found in a previous study when we looked at why marginalised pregnant women fail to access antenatal care in high income countries such as the UK”
Fellow researcher Kenneth Finlayson added: “A second disparity, between the actual services and the expectations of the women who use them, which we called ‘not getting it right the first time’, could be responsible for the lack of continued engagement.”
Professor Downe concluded: “In many ways this new research mirrors what we found in a previous study when we looked at why marginalised pregnant women fail to access antenatal care in high income countries such as the UK. A lot of the time it’s a failure to give compassionate care.”
The authors hope that their work will contribute to a reappraisal of the services available from a ‘one size fits all’ towards new customised service designs based on what works, for whom and in what circumstances.
The paper is available to view online.
*The countries examined for this research were: Bangladesh, Benin, Cambodia, Gambia, India, Indonesia, Kenya, Lebanon, Mexico, Mozambique, Nepal, Pakistan, South Africa, Tanzania and Uganda.
**The World Bank uses a term called the ‘GNI per capita’, i.e. the Gross National Income divided by the population. Countries with a figure of less than $1045 are considered ‘low income’ or ‘low resource’ and most of these are in Sub-Saharan Africa.