Acceptance Of Antenatal Care And Its Influencing Factors In A Rural Minority Area

BackgroundMother to child transmission (MTCT) is one of the main transmission routes of HIV, and the probability of MTCT can be dramatically reduced with comprehensive interventions. The Liangshan Prefecture started the prevention of MTCT program in 2009. However, the implementation of the program is suboptimal and the coverage of HTV testing is still low. Many Yi women (main local minority nationality) did not take antenatal care (ANC) and gave birth to their babies at home for a variety of reasons.ANC plays an important role in prevention of MTCT. Our study site, Zhaojue County in the Liangshan Prefecture, is an area with high HIV prevalence. Local government provides allowance for women who take ANC, deliver in hospital, and finish post-partum examination. Although it has been known that coverage of delivery in hospitals is below the average level of Liangshan, there has been no scientific estimation of implementation of ANC, uptake of ANC and proportion of pregnant women who delivered in hospitals. Facilitators of and barriers to uptake of ANC among local HIV positive women are also unknown.Objectives1) To investigate ANC-related knowledge, acceptance and uptake of ANC among women of child-bearing age in minority area, so as to find reasons of suboptimal implementation of ANC with the promotion by local government;2) To find out influencing factors of ANC uptake as well as factors influencing their intention to take ANC among women of child-bearing age in minority area in order to take measures to improve uptake of ANC, improve maternal and newborn health and reduce MTCT of HIV.MethodsWe used a mixed method combining qualitative and quantitative research. The participants of qualitative research included health providers, young women, young women’s husbands and leaders of the clans. In-depth interviews were conducted with a total of 40 young women,20 husbands,20 clan leaders and 20 health providers. Another 8 focus group discussions were convened among above 4 groups,2 for each group. Information collected in qualitative research included:AIDS-related knowledge, HIV testing and MTCT knowledge, ANC knowledge, uptake of ANC, factors influencing uptake of ANC, etc.The quantitative part of the study was a cross-sectional study using cluster sampling. All women in the selected villages were invited to participate in. The questionnaire was designed based on literatures and experts’suggestions, which included:demographic characteristics, history of pregnancy and ANC, factors influencing uptake of ANC, such as ANC-related knowledge, intention of taking ANC, facilitators of and barriers to ANC uptake, needs for ANC, knowledge and perception of AIDS. SPSS 21.0 was used to conduct statistical analysis. Descriptive analysis were conduct for demographic characteristics, history of pregnancy and ANC, knowledge of and attitudes towards ANC. Influencing factors of uptake and intention of ANC were analyzed, using uptake and intention as dependent variables, demographic characteristics and other relevant variables as independent variables.Results1) In this HIV prevalent area, the AIDS-related knowledge were low among local women and their husbands. The coverage of ANC was low because many people did not know the promotion policies about HIV testing, prevention of MTCT and ANC.2) Structural factors such as poor transportation, low capacity of health providers and insufficient equipment in health facilities were also barriers to uptake of ANC.3) Clans plan an important role in education and promotion of AIDS prevention and ANC.4) Among 538 women we investigated,117 (22.1%) did not know they need to take ANC after pregnancy. Only 130 (24.2%) ever took ANC. However, intention of taking ANC was high (94.6%) among them.5) Multivariate analysis showed that, living outside for over 6 months, giving less than 4 births, knowing ANC after pregnancy and knowing government’s promotion policies for ANC were facilitators of taking ANC. Less than 4 pregnancies, knowing government’s promotion policies for ANC and no needs for accompanying for ANC were for less than facilitators of intention to take ANC.ConclusionsYoung women and their husbands in this minority area had very low levels of knowledge about AIDS epidemic and ANC, so it is necessary to reinforce the education and increase their perception of taking ANC.Although young women had high intention to take ANC, the actual uptake of ANC was low compared to other areas. Efforts should be made to help them turn intention into action.Factors influencing uptake of AND included economic difficulties, transportation, traditional cultures, etc. The government should invest more in infrastructure to increase income of famers and capacity of health facilities.Clans have key roles in people’s daily life and may have potential roles in AIDS prevention and ANC promotion programs. They should act as link between health programs and clan member to increase coverage of ANC.