Article Preview
TopBackground
Antenatal care (ANC) reduces maternal and perinatal mortality and morbidity through detection and treatment of pregnancy-related complications, and the identification of women and girls at increased risk of developing complications during labor and delivery, thus ensuring referral to an appropriate level of care (Kuhnt and Vollmer, 2017; WHO, 2016). ANC is the care given by skilled healthcare providers to pregnant women and adolescent girls in order to ensure the best health conditions for both mother and baby during pregnancy (WHO, 2016). ANC includes risk identification; prevention and management of pregnancy-related or concurrent diseases; and health education and promotion (WHO, 2016). Worldwide, approximately 64% of women had attended four or more ANC visits in 2016 (Ogbo et al., 2019).
ANC services enable the identification of risk factors and early diagnosis of pregnancy complications such as preterm delivery, preeclampsia, anemia, neonatal tetanus, ectopic pregnancy, gestational diabetes, infections and birth defects (Perumal, Cole & Ouédraogo, 2013; Ali et al. 2018; WHO United Nations Children’s Fund & United Nations Populations Fund, 2017). WHO envisions a world where “every pregnant woman and newborn receives quality care throughout the pregnancy, childbirth and postnatal period” (Tuncalp et al. 2015).
ANC services leads to the utilization of other maternal services like institutional delivery and seeking assistance for complications during delivery and postnatal period (Ali et al., 2018; Namatovu, 2018). Good quality ANC services improve the survival and health of mothers and their unborn babies (Tekelab et al. 2019). The attainment of the recommended ANC visits varies between countries, tribe and culture, socio-demographic, geopolitical region, place of residence and socio-economic status. Since ANC is envisioned to improve pregnancy outcomes, it is prudent to understand the conditions that limit its adherence.
Motivation
Across the globe, different interventions for instance the provision of clean delivery kits; training of community health workers (CHW), skilled birth attendants and health care staff on birth preparedness through community mobilization and home visits have been employed to improve ANC attendance and utilization (Lassi et al, 2016). However, little progress has been registered in low and middle-income countries (Awasthi et al. 2018; Islam & Masud, 2018; WHO, 2016; Bloom, Lippeveld & Wypij 1999; Ram and Singh, 2006) with many not achieving the Ali2016). Although several studies have been conducted across the globe to understand the facilitators and barriers of ANC (Anastasi et al. 2015; Ghose et al. 2017; Mugo, Dibley & Agho, 2015; Noh et al. 2019; Ogbo et al., 2019; Wolderufael, 2018; Morgan et al., 2018), many focus on isolated aspects and have not explored ANC utilization in the context of Systems Dynamics. Therefore, the study explored the use of the System Dynamics methodology with the aim of gaining a deeper understanding of the key leveraging points that could possibly improve antenatal utilization in low and middle-income countries, hence being a basis to inform decision-making and better policy formulation.