Background
Methods
The setting and implementation of the CDTFA approach
Data collection
Data analysis
Results
Reasons for early FANC clinic start [Number of women who mentioned the reason (%)] N = 1015 | Reasons for late FANC clinic start [Number of women who mentioned the reason (%)] N = 2132 |
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1. Had knowledge on importance ANC =477 (47) | 1. Husband not available =362 (17) |
2. Adherence to health messages/advice from health workers =142 (14) | 2. No money to pay for FANC services =298 (14) |
3. Went there because of sickness =122 (12) | 3. Own choice =298 (14) |
4. To know if I was pregnant = 92 (9) | 4. Unaware of pregnancy =277 (13) |
5. Encouraged by close relatives/husband =51 (5) | 5. No means of transport =256 (12) |
6. Fear to pay by-law fines =41 (4) | 6. No cloth wraps for the baby to show at FANC =192 (9) |
7. To be well received by nurses during delivery =30 (3) | 7. Lack of knowledge on importance of FANC = 107 (5) |
8. Encouraged by local leaders =30 (3) | 8. Long distance to FANC clinics =107 (5) |
9. No reason given =30 (3) | 9. To reduce FANC visits =85 (4) |
10. Waiting for visible signs of pregnancy = 64 (3) | |
11. Was too sick to go for FANC = 47 (2) | |
12. Cultural beliefs = 21 (1) | |
13. Was outside the country = 21 (1) |
Identified barriers to utilization of FANC in the district
“You cannot be assisted by doctors if you go to the hospital without a spouse. I did not go to ANC clinic early because my husband was in South Africa. I could not afford to pay for the letter from the village head”. – a female participant.
“Our nurses should just be accepting our women to access ANC services even if they go alone. Men in this village feel shy to accompany their spouses to clinics. Starting from parents, pregnancy related issues have always been handled by women”. – male participant.
“Is it possible to stop coercing male partners getting an HIV test when they accompany their spouses to clinics? I see that male partners do not want to accompany their spouses because they do not want to be tested for HIV” – a female participant.
“If my wife tells me that she is pregnant, it becomes difficult for me to source four ‘zitenje’ within three months of her pregnancy as demanded from the nurse at the hospital. In this case, I tell my wife to wait until I find money to buy the four ‘zitenje’. I feel the demand is too much for poor people like us.” - a male participant.
“We have a by-law that was enacted by the chiefs in this area after receiving concerns from the health centre that most men were not accompanying their spouses to ANC clinics. We do not punish pregnant women who do not have spouses. We advise them to go to their village head to collect letters for them to be accepted at the health centre. The fee that she is complaining of is not meant for such pregnant women only. The fee is for any stamped letter that everyone pays when one asks for it from the chief” – a village head.
“The services are not free at our health facility. We pay 2,000 Kwacha [3 US$] to access services which many of us do not afford. Is it possible for government to be paying for us money for ANC so that we can be accessing ANC services free of charge as is done in government facilities?” – a community leader from an area under a CHAM health facility.