Maternal health services are provided in Pakistan through primary, secondary and
tertiary care facilities and utilization for at least one visit is up to 61% in some
areas. In most rural areas, however, antenatal coverage is closer to 10% and most
of Balochistan Province is rural. This study assesses the provision and utilization
of antenatal care (ANC) services and identifies barriers that limit utilization of the
Government’s routine ANC services in a tribal community in Jhal Magsi District
of Balochistan Province, Pakistan.
The study was conducted in the Pattri Union Council of Jhal Magsi District with
both qualitative and quantitative methodologies. Eight focus groups were
conducted among married women and men separately in the villages of Pattri
Union Council and a cross-sectional quantitative survey was conducted among
513 pregnant women aged 18 to 40 years.
Only 14.4% of the study respondents ever had received ANC services at a
government health facility. Short distance from residence to health facility, high
income, less number of parity, any education, any perceived pregnancy related
problem and knowledge about ANC were positively associated with ANC
(p<0.001) utilization. However attitude toward government health facility showed
negative association with such ANC. A multivariable logistic model also showed
significant positive association of family income, education, parity, and distance
from residence to health facility with accessing ANC services. Attitude showed a
negative association. (Knowledge could not be assessed with logistic regression.)
Qualitative data also supported quantitative results as most of the male and female
respondents revealed low knowledge and negative attitudes towards the ANC
services provided at the government health facilities.
Comprehensive health promotion and access to health services in the tribal
community for routine ANC should be increased and implementation should be
more targeted to increase the uptake of routine ANC services. This study suggests
that, at the policy level, participation of women and their husbands in maternal
health promotion programs that increase awareness will have long-term positive
effects on ANC utilization in the Baloch community.