RESULTS: I. BASIC INDICATORS AND RISK ANALYSIS
1. ANTENATAL CARE AND PRACTICES
The women and their pregnancies
The sample includes 19,557 ever-married women aged 15-49 years. Their average age at the time of answering the survey was 30.4 years (s.d. 8.4 yrs). Information was given about a total of 17,609 pregnancies, including 260 women pregnant at the time of the survey. These current pregnancies are included in analyses of antenatal care but excluded in analyses of pregnancy outcome (birth weight estimate and survival of the baby). The mean number of pregnancies the women had previously is 3.7 (s.d. 6.5), median 3.0.
The women were asked how long ago their last pregnancy was. The mean time since the last pregnancy was 5.0 years, (s.d. 4.9 years). For 55% the last pregnancy was 3 years ago or less; for 67% it was 5 years or less ago; and for 85% it was 10 years or less ago. The woman's age at the time of the last pregnancy was calculated by subtracting the time since the last pregnancy from the woman's age at the time of the survey. The mean age at the time of the last pregnancy was 26 years (s.d 6.3 years), median 26 years. The distribution of age at the time of the last pregnancy is shown in Table 2 and Figure 1.
Table 2. Distribution of age of women at the time of their last pregnancy
Age group
No of women
% of women
Up to 15 years
175
1
16 - 24 years
7316
41
25 - 34 years
7734
45
35 years plus
2075
13
Figure 1. Age of women at time of last pregnancy
The National Maternity Care Guidelines have a target of four antenatal visits for each pregnancy. In NMIS cycle 5, women were asked about how many antenatal care visits they had during their last pregnancy. The proportions having no visits, 1-3 visits and 4 or more visits are shown in Table 3 and Figure 2.
Currently, fewer than one in ten women are receiving the number of antenatal care visits that are considered to be desirable in the National Maternity Care Guidelines.
Table 3. Proportion of women receiving different numbers of antenatal care visits (weighted values)
No.of antenatal visits
All pregnancies
No. (%)Pregnancies within 5 yrs
No. (%)0
13374 (80)
8692 (76)
1-3
2567 (13)
2040 (16)
4 or more
1579 (7)
1134 (8)
Three quarters (76%) of Nepali women giving birth within the last 5 years receive no formal antenatal care |
Figure 2. % of women with different numbers of antenatal care visits
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There is variation in the proportion of women receiving formal antenatal care (one visit or more) by geographic area and by ethnicity. This variation is shown in Annex 5, tables A5.1 and A5.5 and Figure A5.1. Note that the figures for individual eco development regions etc are shown unweighted, while the aggregated figure for Nepal is shown weighted. It is clear that routine antenatal care is mainly confined to urban sites. The higher figure among Newari people may be because many of them live in urban or peri-urban areas.
Timing of the first antenatal care visit
The National Maternity Care Guidelines advise that women should seek antenatal care from a trained TBA, MCHW, or ANM as soon as a pregnancy is suspected. However, among women who had any antenatal care visits, only 43% (1857 out of 4162) of them went for their first antenatal visit within the first three months of pregnancy. For pregnancies within the last 5 years, 41% of the women who had antenatal care had the first visit within 3 months.
Reasons for not having antenatal care
The reasons for not having formal antenatal care were explored: women who had not had any antenatal care visits were asked why and the issue was also discussed in focus groups of women in the communities. Table 4 shows the reasons given by women in households for not having formal antenatal care.
Table 4. Reasons given by women who did not have any antenatal care visits during their last pregnancy
Reason Number of women % women No need perceived 4485 34% Not part of local tradition 4184 31% Not aware of a service 3107 23% Too far to health facility 1642 11% No money to pay for visits 648 5% No time to go for visits 301 2% The service is poor 157 1% Family don, t allow to go 136 1% Don, t know/missing 300 2% Total 14780 Note: Up to three reasons were allowed for each respondent
Issues of access, time for visits and payment for visits were raised but the commonest reasons were to do with not perceiving a need for routine antenatal care, which has no part in local traditions, and which women are unaware of as a service. Even when women are aware of the existence of antenatal care services in their area, there is no perceived benefit of routine antenatal care, so it is not seen to be worth the time and effort it entails. If women in Nepal are to be persuaded to have routine antenatal care, much more effort needs to go into marketing the service, including demonstrating the advantages of having such care. Part of the purpose of this survey was to explore whether women who have antenatal care have a better outcome of pregnancy (excluding maternal mortality which was not measured) than those who do not, taking other factors into account (see later).
In focus group discussions, lack of awareness and lack of tradition of having antenatal care were mentioned in three-quarters of the communities (76%). Bad attitudes of staff (8%) and poor facilities (8%) were raised in focus group discussions, although only 1% of household responding women mentioned poor service (see Table 4). Perhaps women felt able to speak more freely in the focus groups. The proportions of focus groups mentioning different reasons for not having antenatal care are shown in Annex 3.
Other factors during pregnancy
Smoking
A sizeable proportion of Nepali women smoke during pregnancy.
Nearly one in three (31%) of Nepali women giving birth within the last 5 years admit to smoking during their most recent pregnancy |
Considering all reported pregnancies, the proportion smoking is little different (34%). The proportion of women who smoke during pregnancy varies by geographic area and by ethnicity. The figures disaggregated by area and by ethnic group are shown in Annex 5, Tables A5.1 and A5.5 and Figure A5.2.
Women were asked how many cigarettes/beedi they smoked per day during pregnancy. Self-reported level of smoking is known to be much less reliable than reports of smoking at all (smokers underestimate the number of cigarettes smoked but are less likely to report themselves as complete non-smokers), so this report does not analyse the data on self-reported level of smoking. However, most of the women smokers reported themselves as light smokers; only 5% of women (17 % of smokers) reported smoking more than 10 cigarettes/beedi per day.
Working during pregnancy
Working during the whole or nearly the whole of pregnancy is the norm in Nepal. This is the same whether all reported pregnancies or only more recent pregnancies are condsidered.
Nearly all the women in the survey (95%) reported that they worked for 8 or 9 months of their last pregnancy. |
The geographic and ethnic variation in working during pregnancy is shown in Annex 5, Tables A5.1 and A5.5 and in Figure A5.3.
Health problems during pregnancy
Women were asked about what health problems, if any, they had experienced during pregnancy. The great majority denied any problems, suggesting that only relatively serious conditions are considered as problems. For example, morning sickness is clearly not reported here as a problem. This may mean that many minor problems, that could nevertheless be an indicator of more serious conditions, are not being noted. For example, it seems likely that ankle oedema (swelling) is not identified as a health problem, but it is often the sign of high blood pressure that can be a serious problem for both mother and baby. Another early warning sign of serious hypertension in pregnancy is the finding of protein in the urine on routine testing; such testing is not undertaken in women who do not attend for antenatal care, who also do not have their blood pressure checked.
Less than one in ten (9%) women in Nepal giving birth in the last 5 years report having a health problem during their last pregnancy |
Table 5 shows the type of health problems reported.
Table 5. Health problems during most recent pregnancy reported by women household respondents (n=17409)
Health problem |
No. women |
% women |
Paine in body/stomach |
617 |
4% |
Weakness |
299 |
2% |
Vomiting/dizziness; |
250 |
1% |
Fever |
252 |
1% |
Swelling of body |
157 |
1% |
Bleeding |
81 |
0.5 |
Headache |
77 |
0.5 |
Urine infection |
25 |
- |
High blood pressure |
15 |
- |
Don’t know / not specified |
158 |
1% |
Note: Up to three problems were allowed for each respondent.
Variables affecting the likelihood of receiving antenatal care
In this section, the effects of variables individually are examined . Analysis of variables in combination is shown in the second Results section. In this section all reported pregnancies are included, since the relationships between antenatal care and other variables are not likely to change with time since the pregnancy.
Smoking
Women who smoke are less likely to have attended for any antenatal care visits. Table 6 shows the relationship.
Table 6. Smoking and antenatal care visits
Smoking during pregnancy |
Antenatal care visits |
|
At least one |
None |
|
Non smoker |
3008(30) |
8564(70) |
Smoker (%) |
525(10) |
4725(90) |
Odds Ration=3.78 (95% CI 3.42-4.18) |
Literacy
A quarter of the women respondents (ever married women aged 15-49) reported being able to read and write a simple letter (the indicator of literacy used in this and other similar studies, including the Nepal national census).
A quarter (25%) of ever-married women of child bearing age in Nepal are literate by self report. |
Literate women are much more likely than illiterate women to have attended for antenatal care during their last pregnancy. This is shown in Table 7.
A quarter of the women respondents (ever married women aged 15-49) reported being able to read and write a simple letter (the indicator of literacy used in this and other similar studies, including the Nepal national census).
A quarter (25%) of ever-married women of child bearing age in Nepal are literate by self report. |
Literate women are much more likely than illiterate women to have attended for antenatal care during their last pregnancy. This is shown in Table 7.
Table 7. Literacy and antenatal care visits
Smoking during pregnancy |
Antenatal care visits |
|
At least one |
None |
|
Literate |
2395 (M |
2200(48) |
Illiterate |
1750(14) |
11167(86) |
Odds Ratio 6.95 (95% CI 6.42-7.51) |
Literacy of household head
Women from families where the household head is literate are over 3 times more likely to attend for antenatal care, as shown in table 8. This is true in both urban and rural areas, and whether the women herself is literate or not.
Table 8. Literacy of household head and antenatal care visits
Literacy of household head |
Antenatal care visits |
|
At least one |
None |
|
Literate (%) |
3092 (33) |
6219 (97) |
Illiterate (%) |
1113 (14) |
7150 (87) |
Odds Ratio 3.13 (95% Cl 2.89 - 3.38) |
Area of residency
Women living in urban areas are nearly 6 times more likely to attend for antenatal care visits than women in rural areas. This is shown in table 9.
Table 9. Area of residence and antenatal care visits
Area of residence |
Antenatal care visits |
|
At least one |
None |
|
Urban (%) |
1385 (57) |
1050 (43) |
Rural (%) |
2761 (18) |
12324 (82) |
Odds Ratio 5.89 (95% Cl 5.37 - 6.46) |
Literacy and smoking
Literate women are less likely than illiterate women to be smokers, as shown in Table 10.
Table 10. Literacy and smoking during pregnancy
Literacy of Women |
Smoking during pregnancy |
|
Non smoker |
Smoker |
|
Literate (%) |
4055 (88) |
534 (12) |
Illiterate (%) |
8176 (63) |
4733 (37) |
Odds Ratio 4.40 (95% Cl 3.98 - 4.85) |
Nevertheless, the greater risk of not having antenatal care among smokers persists when literacy is taken into account by stratification. The association with literacy does not explain the effect of smoking on the likelihood of attending antenatal care.
Age at time of pregnancy
Women younger at the time of pregnancy are more likely to attend for antenatal care than older women. The relationship is shown in Table 11.
Table 11. Age at time of pregnancy and antenatal care visits
Age at time of pregnancy |
Antenatal care visits |
|
At least one |
None |
|
Up to 35 yrs (%) |
3814 (25) |
11344 (75) |
> 35 yrs (%) |
244 (12) |
1822 (88) |
Odds Ratio 2.51 (95% Cl 2.18 - 2.90) |
Family support
Women reporting 'very much' and 'some' support from their families during pregnancy are nearly 3 times more likely to attend for antenatal care than women reporting 'no' support from their families. This is shown in table 12.Table 12. Family support and antenatal care visits
Family support (%) |
Antenatal care visits |
|
At least one |
None |
|
Very much and some (%) |
3904 (25) |
11482 (75) |
None (%) |
198 (10) |
1738 (90) |
Odds Ratio 2.98 (95% Cl 2.55 - 3.49) |
Number of pregnancies
The National Maternity Care Guidelines advise that women should avoid having more than 4 pregnancies. In this survey, women with 4 or more previous pregnancies are less likely to attend for antenatal care visits during the most recent of these pregnancies, as shown in table 13. However, the number of pregnancies is strongly related to the age of women at the time of pregnancy.
Table 13. Number of pregnancies and antenatal care visits
Number of pregnancy |
Antenatal care visits |
|
At least one |
None |
|
Up to 4 times (%) |
3392 (28) |
8932 (73) |
5 or more times (%) |
754 (15) |
4442 (86) |
Odds Ratio 2.24 (95% Cl 2.05 - 2.44) |
Influence of trained TBAs
Women from communities where there was at least one trained TBA (interviewed for this survey) are more likely to attend for antenatal care than those from communities where the interviewed TBA was untrained. This is shown in table 14. This should be interpreted with caution, since no TBA was interviewed in 23 of the 144 communities.
Table 14. Presence of trained TBA and antenatal care visits
Trained TBA in community |
Antenatal care visits |
|
At least one |
No visites |
|
Yes (%) |
1905 (23) |
6410 (77) |
No (%) |
1299 (19) |
5418 (81) |
Odds Ratio 3.13 (95% Cl 2.89 - 3.38) |
Health problems during pregnancy
Women reporting health problems during the pregnancy are more than twice as likely as those not having such problems to have attended antenatal care. This is shown in Table 15.
Table 15. Health problems in pregnancy and antenatal
Health problems during pregnancy |
Antenatal care visits |
|
At least one |
None |
|
Problem (%) |
3584 (40) |
815 (60) |
No problem (%) |
3466 (22) |
12361 (78) |
Odds Ratio 2.40 (95% Cl 2.13 - 2.70) |
This suggests that many antenatal care visits are to seek help for a health problem, rather than for routine, preventive care as they are intended to be. This is in line with the perception (see above) that routine antenatal care is not necessary.
Literate women are actually somewhat more likely than illiterate women to report health problems during pregnancy. This may be because literate women are better aware of health issues generally and of problems to look out for in pregnancy specifically. The association is shown in Table 16.
Table 16. Literacy and health problems during pregnancy
Literacy of women |
Health problem in pregnancy |
|
Problem |
No problem |
|
Literate (%) |
429 (10) |
4074 (90) |
Illiterate (%) |
937 (7) |
11805 (93) |
Odds Ratio 1.33 (95% Cl 1.17 - 1.50) |
The association between health problems in pregnancy and attending antenatal care is not changed when literacy is taken into account by stratification.
Length of working during pregnancy
Women who continue to work for 8 or 9 months in pregnancy are less likely than those who stop work sooner to attend for antenatal care. This is shown in Table 17.
Table 17. Working during pregnancy and antenatal care visits
Working during pregnancy |
Antenatal care visits |
|
At least one |
None |
|
8 or 9 months (%) |
3765 (23) |
12834 (77) |
< 8 months (%) |
353 (43) |
476 (57) |
Odds Ratio 0.40 (95% Cl 0.34 - 0.46) |
This maybe because women with health problems are more likely to stop work before 8 months of pregnancy. This is indeed the case, as shown in Table 18.
Table 18. Health problems in pregnancy and working during pregnancy
Health problems during pregnancy |
Working during pregnancy |
|
8 or 9 months |
< 8 months |
|
Problem (%) |
1139 (84) |
211 (16) |
No Problem (%) |
15230 (96) |
586 (4) |
Odds Ratio 0.21 (95% Cl 0.17 - 0.25) |
The fact of receiving antenatal care does not mean much unless the quality of the care is adequate. The National Maternity Care Guidelines specify certain minimum standards for what should be covered in antenatal care visits. In this survey we collected details about where any antenatal care was received, from what type of health worker, how long into pregnancy, and how much it cost. The quality of antenatal care was examined in this survey partly by interviewing services providers, both staff in health facilities and Traditional Birth Attendants (TBAs). It was also examined by asking women whether they had received doses of tetanus toxoid and iron/folate tablets during the pregnancy, and their views of the problems with antenatal services and possible improvements that could be made.
Source of antenatal care
Women were asked where they received antenatal care. The great majority of those who had any antenatal care visits went to government health facilities. Table 19 shows the reported sources of antenatal care.
Table 19. Reported sources of antenatal care among 4040 women with at least one visit and who could report the source
Source of antenatal care |
No. women |
% women |
District hospital |
2286 | 57% |
Health post |
775 | 19% |
Private clinic |
517 | 13% |
Sub health post |
185 | 5% |
Primary health care centre |
114 | 3% |
Own home |
61 | 2% |
Nursing home |
52 | 1% |
FPA clinic |
50 |
1% |
The high proportion of visits that were to the district hospital suggests that many visits were made because of some perceived health problem rather than as a routine. It also suggests that visits are made by those women who either live close to the district hospital or can afford the time and money for the travel to get there.
The few women who reported they had a health problem during pregnancy were specifically asked where they went to seek help for this problem. Table 20 shows the sources of help used. Of those who sought help anywhere, the district hospital was the most popular source. Very few women reported seeking help from Traditional Birth Attendants, whether trained or untrained.
Table 20. Reported sources of help for pregnancy health problems among 1574 women who could report the source
Source of help |
No. women |
% women |
Did not seek help |
491 | 31 |
District hospital |
400 | 25 |
Private clinic |
215 | 14 |
Sub health post |
210 | 13 |
Health post | 98 | 6 |
Private doctor | 98 | 6 |
Primary health care centre |
35 | 2 |
Untrained TBA |
19 | 1 |
Trained TBA |
8 |
1 |
Person providing antenatal care
Women who received any antenatal care were asked from what type of health worker they got this care. The responses are shown in Table 21. As many as 50% of the women who reported having antenatal care said they were seen by a doctor. Some of these will have been doctors providing care in private clinics.
Table 21. Type of health worker seen for antenatal care among 4170 women who could report this information
Type of health worker |
No. women |
% women |
Doctor |
2064 | 50% |
Assistant nurse midwife |
1516 | 36% |
Auxiliary health worker |
329 | 8% |
Govt. health worker (unspecified) |
114 | 3% |
Maternal and Child Health Worker | 54 | 1% |
Village Health Worker | 49 | 1% |
Female Community Health Volunteer |
21 | 1% |
Untrained TBA |
16 | 0.5% |
Trained TBA |
7 |
0% |
Very few women get antenatal care from TBAs, trained or untrained.
Iron and folate supplements
Few women in Nepal receive iron and folate supplements during pregnancy.
Among women who attended for antenatal care at least once, nearly half (46%) reported taking iron/folate tablets at some stage during the pregnancy. A few (2%) of women who had not attended antenatal care also reported taking iron/folate tablets, presumably having obtained them from local drug shops.
Only one in ten (10%) women receive iron/folate supplements during pregnancy, and only 2% take them for more than three months |
The situation does not seem to have improved in recent years. Of women giving birth within the last 5 years, still only 12% received iro/folate supplements.
The variation in the proportion of women receiving iron/folate supplements in pregnancy by geographic area and by ethnicity is shown in Annex 5, Tables A5.2 and A5.6 and Figure A5.7.
According to the National Maternity Care Guidelines, all women should take iron/folate tablets during pregnancy and these should be supplied when they attend for antenatal care. The big majority of the health facilities visited (89%) said they supply iron/folate tablets to pregnant women. Despite this, even even among the minority of women who have any antenatal care, less then half actually take iron/folate tablets at all. Women in communities where the health facility reports supplying iron/folate tablets are more likely to take iron/folate during pregnancy than those in communities where the facility does not report supplying these tablets. This is shown in Table 22.
Table 22. Supply of iron/folate tablets by health facility and taking iron/folate in pregnancy
Health facility supplies iron/folate |
Women taking iron/folate |
|
Yes |
No |
|
Yes (%) |
1590 (12) |
11701 (88) |
No (%) |
91 (6) |
1343 (94) |
Odds Ratio 2.0 (95% Cl 1.59 - 2.50) |
Tetanus toxoid
The situation with tetanus toxoid is rather complicated because the number of doses a woman should receive during a pregnancy depends upon how many doses she has previously received. As an indicator of care, we have used the number of women who are given at least one dose of tetanus toxoid during the pregnancy.
Four out of ten women (42%) received at least one dose of tetanus toxoid during their last pregnancy |
The variation in the proportion of women receiving at least one dose of tetanus toxoid during their last pregnancy by geographic area and by ethnicity is shown in Annex 5, Tables A5.2 and A5.6 and Figure A5.6.
There is evidenc fo some improvement over time, in that among women giving birth within the last five years, 50% received at least one dose of tetans toxoid.
Since more women report receiving tetanus toxoid than report attending for antenatal visits, clearly many women must receive the tetanus toxoid from other sources. For example, this might be from mobile vaccination teams coming into villages. Most (95%) of the health facilities serving the sites report they give injections of tetanus toxoid to pregnant women. But women in communities where the health facility reports giving tetanus toxoid are somewhat less likely to have tetanus toxoid in pregnancy than women from other communities. This is shown in Table 23.
Table 23. Provision of tetanus toxoid by health facility and receiving tetanus toxoid in pregnancy
Health facility provides tetanus toxoid |
Working receiving tetanus toxoid |
|
Yes |
No |
|
Yes (%) |
6113 (43) |
8066 (57) |
No (%) |
420 (53) |
373 (47) |
Odds Ratio 0.67 (95% Cl 0.58 - 0.78) |
Cost of antenatal care
Women who attended for antenatal care during their last pregnancy were asked how much they had to pay per visit. For the 4170 women who were able to give a cost figure, the mean payment per visit was 223 Rs, and the median was 60 Rs.
Advice given in antenatal visits
According to the National Maternity Care Guidelines, the place of delivery and breast feeding issues should be discussed with women at antenatal care visits. Women who had attended for antenatal care were asked if they were advised about these issues. Most reported they were not advised: only a quarter (25%) recalled a discussion about place of delivery and only a quarter (25%) reported being advised about breast feeding.
The advice that health facilities and TBAs report giving to pregnant women is shown in Tables 24 and 25.
Women who attended for antenatal care during their last pregnancy were asked how much they had to pay per visit. For the 4170 women who were able to give a cost figure, the mean payment per visit was 223 Rs, and the median was 60 Rs.
Advice given in antenatal visits
According to the National Maternity Care Guidelines, the place of delivery and breast feeding issues should be discussed with women at antenatal care visits. Women who had attended for antenatal care were asked if they were advised about these issues. Most reported they were not advised: only a quarter (25%) recalled a discussion about place of delivery and only a quarter (25%) reported being advised about breast feeding.
The advice that health facilities and TBAs report giving to pregnant women is shown in Tables 24 and 25.
Table 24. Advice reported given by health facilities and TBAs about place of delivery
Type of advice |
No % facilities |
No (%) TBAs |
Clean, dry place |
94 (71) | 156 (88) |
Well ventilated place |
90 (68) | 102 (58) |
Well lit place |
54 (41) | 93 (53) |
Go to Primary Health Care Centre |
28 (41) | 12 (7) |
No dust or smoke | 15 (11) | 8 (5) |
Line with cowdung | 7 (5) | 4 (2) |
Don't know/no advice |
0 |
9 (5) |
It is notable that the same pattern of advice is given by both health facilities and TBAs.
Table 25. Advice reported given by health facilities and TBAs about breast feeding
Type of advice |
No % facilities |
No (%) TBAs |
Use colostrum |
91 (69) | 105 (59) |
Clean nipples |
64 (48) | 101 (57) |
Feed frequently |
46 (35) | 41 (23) |
Start immediately |
43 (33) | 6 (3) |
Exclusive for 6 months | 0 | 21(12) |
Don't know/no advice |
0 |
12 (7) |
Again, a similar pattern of advice is reported by both health facilities and TBAs.
Satisfaction with quality of antenatal care
Household respondents were asked about their satisfaction with antenatal care services and what problems they perceived with the current service. Table 26 and Figure 3 shows satisfaction with the antenatal services received.
Table 26. Reported satisfaction with antenatal care services
Level of satisfaction |
No. women |
% women |
Not at all satisfied |
218 | 5% |
Somewhat satisfied |
2548 | 59% |
Very satisfied |
1653 |
36% |
Figure 3.
Proportion of women with different levels of satisfaction with antenatal care
Note that responses to this question were mainly confined to those women who had attended for formal antenatal care.
The satisfaction with antenatal care by ethnic groups and by geographic location is shown in Annex 5, Tables A5.1 and A5.5, and Figure A5.4.
Table 27 shows the perceived problems with antenatal care services.
Table 27. Perceived problems with antenatal care services reported by 17537 women
Problem |
No. women |
% women |
Don't know |
12848 | 73 |
Poor facilities | 1283 | 7 |
Long waiting times | 977 | 6 |
No medicines | 927 | 5 |
No staff |
915 | 5 |
Bad attitude of staff |
715 | 4 |
No access to facilities |
535 | 3 |
Have to pay | 226 | 1 |
No problem/missing |
708 |
4 |
Note: Up to 3 problems were allowed per respondent
In focus groups, similar views about the problems with antenatal care services were voiced. The focus group responses are shown in Annex 3.
Suggestions for improving antenatal care services
Suggestions about how to improve antenatal care were sought in the household questionnaire, in the focus group discussions of women in the sites, and from the workers in the health facilities serving the sites.
Table 28 shows the household suggestions for what services could do to improve antenatal care, while Table 29 shows their suggestions for what communities themselves could do to help.
Table 28. Suggestions for how services could improve antenatal care from 17294 women
Suggestion |
No. women |
% women |
Don't know/mission |
10075 | 58% |
More health posts etc | 2817 | 16% |
Better quality service |
2569 | 15% |
Train staff | 2186 | 13% |
More medicines | 1793 | 10% |
More staff | 723 | 4% |
Educate women |
350 |
2% |
Note: Up to 3 suggestions were allowed per respondent.
Table 29. Suggestions for how communities could help pregnant women (from 17352 women)
Suggestion |
No. women |
% women |
Don't know/mission |
7758 | 45% |
Less work for women | 6341 | 37% |
Provide transport |
1976 | 11% |
Assist with cash/ kind | 1727 | 10% |
Community groups | 1555 | 9% |
Better diet for pregnant women | 538 | 3% |
Train FCHVs |
296 |
2% |
Note: Up to 3 suggestions were allowed per respondent.
Focus group suggestions for improving care for pregnant women are shown in Annex 3. Nearly a third of focus groups (30%) mentioned that providing female doctors would help improve services and make them more acceptable to women. And 20% of groups suggested there should be free antenatal care. Asked about what else could help, focus groups mentioned (33%) the need to give pregnant women more help with household work and the need to create awareness about good care and practices in pregnancy (32%).
The views of health workers in health facilities on how to improve antenatal services are shown in Table 30.
Table 30. Suggestions from workers in health facilities on how antenatal services could be improved
Suggestion |
No. women |
% women |
More health facilities | 72 | 55% |
Staff training | 55 | 42% |
More medicines | 41 | 31% |
More hospitals | 35 | 27% |
More staff | 29 | 22% |
Regular check ups | 21 | 17% |
Better home care | 19 | 14% |
More funding | 11 | 8% |
Early referral |
6 |
5% |
Note: Up to 3 suggestions were allowed per respondent.
There are many points of similarity between the suggestions of women and those of the health workers.