THESIS

FACTORS AFFECTING UTILIZATION OF ANTENATAL CARE (ANC) SERVICES

AMONG WOMEN OF CHILDBEARING AGE IN WARDI HEALTH CENTER,
MOGADISHU-SOMALIA

CANDIDATE

HAWO ABDULAHI OSMAN HASSAN

ID: 19540

A RESEARCH THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE

REQUIREMENT FOR THE AWARD OF BACHELOR DEGREE IN PUBLIC
HEALTH AT UNIVERSITY OF SOMALI

July, 2020
 DECLARATION
I hereby declare that this proposal is my original work and has not been presented for an
award in any other University for any academic award. I also declare that any secondary
information used has been duly acknowledged in this dissertation.

Name of candidate: HAWA ABDULAHI OSMAN HASSAN

Date: ____/____/______

Signature of candidate: _______________________

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 SUPERVISOR APPROVAL
This thesis have been written with my guidance and supervision and thus recommend it for
submission for further consideration.

Yours Sincerely,

Name of supervisor: Mr. Abdiwali Mohamed Inshar

Title: _________________________________________________________________

Signature: _________________ Date: ___/___/______

Head school of public health

Mr. Abdirizak Mohamed Abdi

Signature................................... Date: ___/___/2020

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 EXAMINING PANEL APPROVAL
This senior project entitled this study Factors affecting utilization of antenatal care (anc) services
among women of childbearing age in wardi health center, mogadishu-somalia by Mr.
Abdiwali Mohamed Inshar in partial fulfillment of the requirement for the award of Bachelor degree
of Public Health has been examined and accepted by examining panel with a grade of
______________________.

Name and Signature of Chairman of Examining Panel

_________________________________________________________________

Name and Signature of Panelist

_________________________________________________________________

Name and Signature of Panelist

_________________________________________________________________

Name and Signature of Dean School of Public Health

__________________________________________________________________

Date: __________/_________/________________

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 DEDICATION
First, I thank all to ALLAH who created me and gave this opportunity to fulfill this book.

I dedicate this work to my dear lovely soul and also google scholars.

I also dedicate my honourable dear supervisor for his guidance and patience.

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 ACKNOWLEDGEMENTS
My sincere gratitude goes to Allah who gave me power, love, provision and divine
enablement to complete this work. My special gratitude goes to my dear supervisor Mr
ABDIWALI MOHAMED INSHAR for his professional advice and guidance as I am writing
the project report. His continuous communication and availability throughout the study time
will help me finish my project in time.

I am also grateful to all my lecturers for their tactful input in knowledge to me. My gratitude
goes to the in UNISO, OSMAN GEDI RAGE Campus for offering the Bachelor Degree in
Public health as a fulltime course, thus giving me an opportunity to conveniently do the
course.

My sincere gratitude goes to the 2016/2020 Bachelor Degree in Public health class for their
assistance and encouragement throughout the course. The continuous discussions and
consultation is greatly appreciated.

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 ABSTRACT
The study focused on assess antenatal care utilization factors among women of childbearing
age in Wardi health Center, Mogadishu Somalia. The purpose of this study is to assess
antenatal care utilization factors among women of childbearing age in Wardi health Center,
Mogadishu Somalia. Three research questions have been formulated to guide the study. The
study employed descriptive research design. The study targeted was 70 from four health
centers in Warta Nabada, Mogadishu Somalia. However, the sample size was 60 consisted of
30 of them generalized tetanus 20 was Localized tetanus the last 10 were both. Simple
random sampling technique was used and data was collected using structured questionnaires.
Statistical package for social sciences (SPSS) version 21 was used to analyze data that was
then presented in tables, bar charts and percentages. The findings of the study revealed that
that health care workers’ attitude is an important consideration if we want to improve the
uptake of ANC services, and Waiting time had influence on utilization of ANC services
while more than a third of the respondents pointed that long waiting time discourages clients
from coming for the services since it wastes their valuable time. Recommendations, the study
recommends development of policies and public health programs focusing on increased
awareness and behavioral change among pregnant women attending health centers to receive
antenatal care services as well as other high risk groups in the population, Government
engagement of free health services or cost sharing mechanism. The findings may also be used
as a basis for further research with the aim to improve antenatal care utilization factors
among women of childbearing age in Wardi health Center, Mogadishu Somalia.

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 Table of Contents
DECLARATION .................................................................................................................. ii
SUPERVISOR APPROVAL ................................................................................................ iii
EXAMINING PANEL APPROVAL .................................................................................... iv
DEDICATION ...................................................................................................................... v
ACKNOWLEDGEMENTS.................................................................................................. vi
ABSTRACT ....................................................................................................................... vii
CHAPTER ONE ................................................................................................................... 1
1.0 Introduction ..................................................................................................................... 1
2.0 Background of the study .................................................................................................. 1
1.2 Problem statement ........................................................................................................... 4
1.3 Justifications ................................................................................................................... 4
1.4 General objectives ........................................................................................................... 5
1.4.1 Specific objectives ................................................................................................................ 5
1.5 Research questions .......................................................................................................... 5
1. How do socio-demographic factors influence utilization of antenatal care services among
women of childbearing age in Wardi health Center? .............................................................. 5
1.6 Significance of study ....................................................................................................... 5
1.7 Scope of study ................................................................................................................. 6
1.7.1 Content scope ....................................................................................................................... 6
1.7.2 Geographic scope .................................................................................................................. 6
1.8 Operational definitions .................................................................................................... 6
CHAPTER TWO .................................................................................................................. 9
2.0 Introduction ..................................................................................................................... 9
2.1 Socio- Demographic factors and utilization of antenatal care services............................ 11
2.2 Knowledge about Antenatal Care Services and Utilization of ANC services .................. 14
2.3 Accessibility of ANC services and Utilization of ANC services..................................... 15
2.4 Research gap ................................................................................................................. 16
2.5 Conceptual Framework ................................................................................................. 17
CHAPTER THREE............................................................................................................. 19
3.0 Introduction ................................................................................................................... 19
3.1 Research Design ............................................................................................................ 19

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3.2 Research Population ...................................................................................................... 19
3.3 Study Area .................................................................................................................... 19
3.4 Inclusion and Exclusion criteria ..................................................................................... 19
3.4.1 Inclusion criteria ................................................................................................................. 19
3.4.2 Exclusion criteria ................................................................................................................ 19
3.5 Sample size determination ............................................................................................. 19
3.6 Sampling Procedure ...................................................................................................... 20
3.7 Data Collection Method................................................................................................. 20
3.8 Data Analysis ................................................................................................................ 20
3.9 Research Quality ........................................................................................................... 21
3.9.1 Validity............................................................................................................................... 21
3.9.2 Reliability ........................................................................................................................... 21
3.10 Limitations .................................................................................................................. 21
3.11 Ethical Considerations ................................................................................................. 21
CHAPTER FOUR ............................................................................................................... 22
4.0 Introduction ................................................................................................................... 22
CHAPTER FIVE ................................................................................................................ 43
5.0 Introduction ................................................................................................................... 43
5.1 Findings ........................................................................................................................ 43
5.2 Conclusion .................................................................................................................... 44
5.3 Recommendations ......................................................................................................... 45
REFERENCES ................................................................................................................... 46

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List of table
Table 4.1 Respondent by Gender ......................................................................................... 23
Table 4.2 Respondent by age ............................................................................................... 24
Table 4. 3. Marital Status .................................................................................................... 25
Table 4.4 level of occupation............................................................................................... 26
Table 4.5 Level of education ............................................................................................... 27
Table 4.6 How did you hear about Antenatal Care Services? ............................................... 28
Table 4.7 In your view when should pregnant women access Antenatal Care Services?....... 29
Table 4.8 How many visits should a pregnant make to the Antenatal Care Services during the
entire period of pregnancy? ................................................................................................. 30
Table 4.9 Is the Antenatal Care Service accessible? ............................................................. 31
Table 4.10 What means of transport do you use when accessing Antenatal Care Services? .. 32
Table 4. 11. How much do you pay for transport to and from the services? ......................... 33
Table 4.12 Do you pay for the Antenatal Care Services? ..................................................... 34
Table 4. 13 If yes, how much? ............................................................................................. 35
Table 4.14 Do you access Antenatal care services during all your pregnancies? .................. 36
Table 4.15 Where do you attend Antenatal Care Clinics? .................................................... 37
Table 4.16 How many people attend to you when you access Antenatal Care Services at the
clinic?.38
Table 4. 17. How would you rate the attitude of service providers towards pregnant women?
........................................................................................................................................... 39
Table 4.18 Are you always referred in case of health problem? ........................................... 40
Table 4. 19 How long does it take to access Antenatal Care Service? .................................. 41
Table 4. 20 Are you satisfied with the Antenatal Care Services rendered? Which number rates
your satisfaction? ................................................................................................................ 42

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List of figures
Figure 4.1 Respondent by Gender ....................................................................................... 23
Figure 4.2 Respondent by age ............................................................................................. 24
Figure 4.3 Marital Status ..................................................................................................... 25
Figure 4.4 level of occupation ............................................................................................. 26
Figure 4.5 Level of education .............................................................................................. 27
Figure 4.6 How did you hear about Antenatal Care Services? .............................................. 28
Figure 4.7 In your view when should pregnant women access Antenatal Care Services? ..... 29
Figure 4.8 How many visits should a pregnant make to the Antenatal Care Services during
the entire period of pregnancy? ........................................................................................... 30
Figure 4.9 Is the Antenatal Care Service accessible? ........................................................... 31
Figure 4.10 What means of transport do you use when accessing Antenatal Care Services? 32
Figure 4.11 How much do you pay for transport to and from the services? .......................... 33
Figure 4.12 Do you pay for the Antenatal Care Services? .................................................... 34
Figure 4.13 If yes, how much? ............................................................................................ 35
Figure 4.14 Do you access Antenatal care services during all your pregnancies? ................. 36
Figure 4.15 Where do you attend Antenatal Care Clinics? ................................................... 37
Figure 4.16 Table 4.16 How many people attend to you when you access Antenatal Care
Services at the clinic? .......................................................................................................... 38
Figure 4.17 How would you rate the attitude of service providers towards pregnant women?
........................................................................................................................................... 39
Figure 4.18 Are you always referred in case of health problem? .......................................... 40
Figure 4.19 How long does it take to access Antenatal Care Service? .................................. 41
Figure 4.20 Are you satisfied with the Antenatal Care Services rendered? Which number
rates your satisfaction? ........................................................................................................ 42

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 CHAPTER ONE
INTRODUCTION

1.0 Introduction
This chapter outlines and in attendance the research background, statement of the problem,
justification, research objectives (General and specific objectives), research questions,
significance of study, scope of the study, (geographical scope, time scope, content of scope)
and finally definition of key words.

2.0 Background of the study

In world, in 2016, at the start of the Sustainable Development Goals (SDGs) era, pregnancy-
related preventable morbidity and mortality remains unacceptably high. While substantial
progress has been made, countries need to consolidate and increase these advances, and to
expand their agendas to go beyond survival, with a view to maximizing the health and potential
of their populations. Sustainable development Goal 3 is to ensure healthy lives and promote
well-being for all at all ages. This goal calls for achieving universal access to sexual and
reproductive health care, reducing global maternal death rates, and ending the AIDS epidemic
by 2030. Reproductive health problems are a leading cause of ill health and death for women
and girls of childbearing age in developing countries. Global strategies have been designed to
increase access to antenatal care that provides high quality service, but there are barriers to
compliance. Women and society may not consider antenatal care a necessity during pregnancy.
The women less likely to attend ANC have been described as having their residence in rural
areas, possessing a low level of education and few socioeconomic resources. (WHO et al 2003).
Antenatal care is the most important method for detecting pregnancy problems in the early
period, because Antenatal care is the best mechanism to minimize maternal mortality, and give
good information for pregnant women about their birth and how to prevent related problems.
The best and most advantage of Antenatal Care is to protect the health of women’s and their
infants as well as indicating the danger signals that will be occurred and needs to be further
treated by advanced health professionals. However, Antenatal Care have such attractive
benefits and strategies, according to the United Nations Millennium Development Goals, every
year, at least half a million women and girls die as a result of complications during pregnancy,
childbirth or the six weeks following delivery. Almost all (99%) of these deaths occur in

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developing countries. This shows that the Antenatal care activity is very weak in developing
country.

However, many women in Africa, under-utilize FANC services. Usually they come late for the
services and make fewer than recommended number of FANC visits. In Niger Delta, 77% of
the pregnant women start utilizing FANC in the second trimester (Ndidi and Oseremen 2010)

In Africa, early entry to antenatal care (ANC) is important for early detection and treatment of
adverse pregnancy-related outcomes. The World Health Organization (WHO) recommends
that pregnant women in developing countries should seek ANC within the first 4 months of
pregnancy. Approximately 536,000 maternal deaths occur annually, of which over 95% occur
in sub-Saharan Africa and Asia. Globally 30% of women between the age group of 15-40 years
do not have ANC, 46% of those who did not have ANC are in South Asia while 34% are in
sub-Saharan Africa. This low use of services leads to death and disability due to untreated
hypertensive disorders or due to mal- or sub-nutrition like iron deficiency anemia .

Africa has the highest burden of maternal mortality in the world and sub-Saharan Africa is
largely responsible for the dismal maternal death figure for that region, contributing
approximately 98% of the maternal deaths for the region. Effects of antenatal care services on
birth-weight, the importance of model specification and empirical procedure were used in
estimating the marginal productivity of health inputs.

According to a report of Mexican DHS, socio-economic and other factors are linked to
differentials in maternal mortality. For instance, women with no formal education are 9 times
more likely to die than those women who have finished high school and women who live in
highly marginalized areas are 3 times more likely to die than those who live in the least
marginalized areas. (Bilenko, 2007)

In Kenya 45% in the third trimester (Magadi et al. 1999). In Malawi 48% of the pregnant
women start utilizing FANC in the second trimester (Malawi Demographic and Health Survey
2010). In terms of number of visits, in developed countries, 97% of the pregnant women make
at least one antenatal visit and 99% of these pregnant women deliver with skilled birth
attendants (Mrisho et al. 2009). To the contrary, in developing countries, including Malawi,
49% of pregnant women make at least have one FANC visit and oftentimes two thirds of these
women deliver with unskilled birth attendants (Mrisho et al. 2009; MDHS 2010). Studies have

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linked low utilization to poor pregnancy outcomes, which ultimately lead to higher maternal
and neonatal morbidity and mortality (Raatikainen et al. 2007).

In Somalia, access to health care services is improving, the country has faced challenges in
increasing health care utilization and the proportion of women who give birth with the
assistance of skilled attendants is the lowest in Sub-Saharan Africa. Somalia is a situated north
of the equator on the horn of Africa. The country is sharing borders with the Republic of
Djibouti, Federal Republic of Ethiopia and Somalia to the east. The government of Somalia
uses a republican system with three arms of government namely: the Legislative, Executive
and the Judiciary, with each arm exercising its exclusive powers independently as accorded
under the Constitution. Somali is the official language, but Arabic and English are other official
languages used and the religion practiced is Islam. Mogadishu is the capital city of Somalia,
The backbone of the economy is livestock exports in the Middle Eastern countries. The
approximate population of Mogadishu is 3.85 million. 2009 with an annual population growth
rate of 3.14%. The life expectancy at birth is between 49 and 60 years. Half of the population
lives in rural and urban areas and the other half are nomads. About 65% of the population
depends either directly or indirectly on livestock and livestock products for their livelihood.
The health care system was seriously damaged during to the civil war and conflicts in the
1990s. This led to low socio-economic status especially among many women and girls and
caused a lack of education and health care services. Currently, the government of Somalia aims
to rebuild, establish health institutions and improve the health care system for the entire
population (UNHCR 2014). While comprehensive information for Somalia is not available it
is estimated that the country’s maternal and child mortality rates are among the highest in the
world. The maternal mortality ratio for Somalia was estimated at (MMR 980/100,000 live
births, IMR 72/1000 live births) in 2013, a reduction from 1300 per 100 000 live births in 1995
(WHO 2014). Almost one out of 10 children is estimated to die before their first birthday. The
leading causes of infant mortality are illnesses like neonatal disorders, pneumonia and diarrhea.
Women die due to pregnancy related causes, only 9 % have access to an SBA during childbirth
and the service of maternal and reproductive health care is very low. The modern contraceptive
rate, which is typically used for birth spacing purposes, is only 1 %. This together with low
access to maternal health care, family planning, skilled birth attendance and high fertility rates
put the women in Somalia at a high risk of mortality and morbidity related to pregnancy and
childbirth (WHO 2014).

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It’s perceived that one of the reasons behind these high rates include low utilization of antenatal
care services in Somalia. Empirical evidence has shown that antenatal care services play an
important role in improving maternal and newborn health outcomes. The focus of antenatal
care services includes ensuring availability, accessibility, affordability and acceptability of
these services. As such provision of antenatal care services creates a platform for educating the
mother on pregnancy danger signs, detecting any complications at an early stage and advising
the pregnant women to seek appropriate treatment on time. Mogadishu, Somalia has a well-
defined antenatal care services program provided at the Maternal and child health centres
(MCHs). However, the utilization of antenatal care services is low with country indicators
stating only 20% of pregnant women utilize antenatal care services (MOH, 2013). The low
rates are suggested to be due to low levels of trust and confidence with the healthcare providers
in the MCHs, confidence with the care provided by traditional birth attendants at home.

1.2 Problem statement

Strategies have been designed globally to increase access to high quality antenatal. Somalia
has the intention to follow the globally designed strategies. Previous studies have shown that
there are barriers to compliance of global and national strategies when establishing ANC
services. In Mogadishu, Somalia, the rate of utilization antenatal care services is very low
estimated at 20% according to the Ministry of Health Somalia Report of 2013. This is known
to contribute towards the high maternal mortality rate in Somalia standing at 732/100, 000 live
births according to the 2015 Ministry of Health report. Since more knowledge is needed to
identify specific barriers to ANC among the most vulnerable female population in Mogadishu.
Therefore this study aims at determining factors influencing utilization of Antenatal Care
services among women in Mogadishu, Somalia. Further the study will determine the specific
factors under availability, accessibility, affordability and acceptability that affect utilization of
antenatal care services in the district. Moreover, the study will inform the design of strategies
that will seek to improve the uptake of ANC services thereby positively impacting on reducing
high infant and maternal mortality in Somalia.

1.3 Justifications
This study will focus on the Factors affecting utilization of antenatal care services among
women childbearing age in Wardi health Center. because Somalia is one of the poorest country
that has not, Factors affecting utilization of antenatal care services and the government of
Somali is the one which is responsible of antenatal care services that are import every day from

4
the sea boat but they neglected their responsibilities, Factors affecting utilization of antenatal
care services among women childbearing age in Wardi health Center. So the purpose that I
choose this topic is to contribute the desired outcome and help to increase awareness of the
burden of these health problems to policy makers and concerned agencies, so as to interrupt
and reduce its prevalence.

1.4 General objectives

To assess antenatal care utilization factors among women of childbearing age in Wardi health
Center. Mogadishu-Somalia.

1.4.1 Specific objectives

1. To establish the extent to which socio-demographic factors influences utilization of
Antenatal care services among women of childbearing age in Wardi health Center.
2. To determine the influence of the knowledge and awareness women have about
antenatal care services on the utilization of Antenatal care services by women
childbearing age in Wardi health center.
3. To determine the influence of accessibility of the ANC services on utilization of
Antenatal Care services by women of childbearing age in Wardi health Center.

1.5 Research questions

1. How do socio-demographic factors influence utilization of antenatal care services
among women of childbearing age in Wardi health Center?
2. To what extent does knowledge and awareness on Antenatal care services influence the
utilization of antenatal care services among women of childbearing age in Wardi health
Center?
3. How does the accessibility of antenatal care services provided affect the utilization of
antenatal care services among women of childbearing age in Wardi health Center?

1.6 Significance of study

This study is intended to assess antenatal care services utilization factors among women of
childbearing age in Wardi Health Center The delivery of antenatal care services in an
appropriate way may enable the pregnant women utilize these services thereby reducing on the
cases of maternal mortality and morbidity, still births and early neonatal deaths within the
community. The findings of the study can be useful to the country’s health care system in
decision making on the provision of antenatal services in different health care facilities, and

5
will also serve as a reference for giving intervention accordingly by the Ministry of Health
Development and others who concerned; for conducting further researches, the findings of this
study will have special importance for health care providers because it will serve as base line
for filling gaps of the actual practices on antenatal care by improving uptake of these services.

1.7 Scope of study

1.7.1 Content scope
The scope of this research is to identify antenatal care utilization factors among women of

childbearing age in Wardi health Center.

1.7.2 Geographic scope

The geographically this study is conducting in Wardi Health Center Mogadishu Somalia

1.7.3 Time scope

This study will be conduct June 2020 to July 2020

1.8 Operational definitions

Accessibility refers to the quality of being available when needed.

Antenatal care service is the care you receive from healthcare professionals during your
pregnancy. The purpose of antenatal care is to monitor your health, your baby’s health and
support you to make plans which are right for you.

Cultural beliefs is the totality of socially transmitted behavior patterns, arts, beliefs,
institutions, and all other products of human work and thought. Culture is learned and shared
within social groups and is transmitted by non genetic means.

Education is the process of facilitating learning. Knowledge, skills, values, beliefs, and habits
of a group of people are transferred to other people, through storytelling, discussion, teaching,
training, or research.

Income level here refers to the amount of money derived from paid employment and
comprising mainly of wages and salary

Knowledge is a familiarity, awareness or understanding of someone or something, such as

facts, information, descriptions, or skills, which is acquired through experience or education

6
by perceiving, discovering, or learning. In other words, it is awareness or familiarity gained by
experience of a fact or situation.

Marital status is the state of being single, married, separated, divorced, or widowed.

Quality is the standard of something as measured against other things of a similar kind; the
degree of excellence of something.

Socio-demographic factors are age ethnicity, sex, marital status and family size of the women
in the reproductive age.

Utilization means to put to use, especially to make profitable or effective use of something. In
this case, it is the effective use of the antenatal care services.

Women of the Reproductive age group are the ones in the reproductive age span, assumed
for statistical purposes to be 15-49 years of age.

Maternal death or maternal mortality is defined by the World Health Organization (WHO)
as "the death of a woman while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and site of the pregnancy, from any cause related to or aggravated
by the pregnancy or its management but not from accidental or incidental causes.

Factor is the ratio of the time that a piece of equipment is in use to the total time that it could
be in use.

Infant mortality is the death of young children under the age of 1. This death toll is measured
by the infant mortality rate, which is the number of deaths of children under one year of age
per 1000 live births.

Morbidity is any physical or psychological state considered to be outside the realm of normal
well-being. The term morbidity is often used to describe illness, impairment, or degradation of
health, especially when discussing chronic and age-related diseases which can worsen over
time

Mortality is the condition of being mortal or susceptible to death the opposite immortality.

Neonatal period (birth to 1 month) is a time of extensive and ongoing system transition from
uterine environment to external world; this includes the initial period after birth which is

7
referred to as the prenatal period. It would seem obvious to say that development does not stop
at birth.

Pregnancy, also known as gestation, is the time during which one or more offspring develops
inside a woman.

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 CHAPTER TWO
LITERATURE REVIEW

2.0 Introduction
The World Health Organization estimates that 515,000 women die each year from pregnancy
related causes and almost all of these deaths occur in developing countries. Less than one
percent of these deaths occur in developed countries indicating that the deaths could be avoided
if resources and services were available (WHO, 1994).

Antenatal care which is known as care during pregnancy is essential for diagnosing and
treating complications that could endanger the lives of mother and child. Most life threatening
obstetric complications can be prevented through antenatal care. Moreover, there is sufficient
evidence that care during pregnancy is an important opportunity to deliver interventions that
will improve maternal health and survival during the period immediately preceding birth and
after birth. Furthermore, if the antenatal period is used to inform women and families about
danger signs and symptoms and about the risks of labour and delivery, it may ensure that
pregnant women deliver with the assistance of a skilled health care provider.

Antenatal care is a potentially important way to link a woman with the health system which if
functioning well, will be critical for saving her life in the event of a complication (UNICEF

2004).The antenatal period also offers opportunities for delivering health information and
services that can significantly enhance the well-being of women and their infants, but this
potential is yet to be realized. Antenatal visits offer entry points for a range of other
programmes including information on nutrition and the prevention of malaria, HIV infection,
tetanus and tuberculosis, as well as obstetric care (UNICEF, 2004).

While antenatal care can be an important tool in diagnosing and preventing risks during
pregnancy, many women in developing countries do not use this service. Using a three level
linear regression model, data from the 1993 Kenya Demographic and Health Survey were
analyzed to determine the frequency and timing of use of antenatal care services. The result
showed that the median number of antenatal care visit was four and the first visits occur in the
fifth month of the pregnancy on average (Magadi, Thembi and Thansjo, 2000). Use of antenatal
care is started later and is less frequent for unwanted and mistimed pregnancies. Even women
who appear to use antenatal care frequently are less likely to use the services for a mistimed

9
pregnancy. Long distance to the nearest antenatal care facility is an obstacle to antenatal care
(Magadi et al, 2000)

Tandu-Umba, Mbangama, Kamongola, Kamgang, Kivuidi, Munene, Meke, Kapuku, Kondoli,

Kikuni, and Kasikila (2014) found out in their study that pregnancy adverse outcomes are
strongly influenced by either non-pathologic or pathologic pre-pregnancy risk factors at first
antenatal visit booking. The recurrence potential of complications is one reason to establish the
predictability and preventability of morbidity such that the most appropriate referrals and best
options throughout the pregnancy can be determined.

The factors that prevent women in developing countries from getting the lifesaving health care
needs include: cost (direct fees as well as the cost of transportation, drugs and supplies);
multiple demands on women’s time; women’s lack of decision-making power within the
family. The poor quality of services, including poor treatment by health providers, also makes
some women reluctant to use the services (WHO, 1997).

Rani, Bonu and Harvey (2008) state that ANC is central to the continuum of medical care that
is necessary before and during pregnancy, at childbirth, and postpartum. ANC is important in
reducing maternal mortality, low birth weight, and prenatal morbidity and mortality. It is also
an opportunity for mothers to access skilled care at delivery, usually at a health facility. In
many developing countries, however, maternal mortality rates continue to be high, with many
deaths the result of complications related to pregnancy and childbirth (Ronsmans and Graham
2006). Further, many women are prone to injuries associated with pregnancy and delivery,
which may result in adverse consequences for both themselves and their families (Abouzar and
Wardlaw 2001, Fotso 2008).

Increasing utilization of antenatal services however has not led to the expected commensurate
reduction in maternal mortality rate (MCHFP, 1993). This is an indication that there is an
improper or inappropriate utilization of these services. People may attend antenatal clinics
alright but may delay till complications of pregnancy have set in or when they are about to
deliver. In developing countries, most attendance at antenatal clinics takes place in the 7th and
8th months and women usually averaged only one visit per pregnancy (Williams0. 1972).
Patients may also report to antenatal clinics only when they are ill (Ledward, 1982). McCaw-
Binns, Mullings and Holder (2008) in Jamaica, observed that commencement of antenatal care
in the first trimester appeared to reduce the risk of all prenatal death and for interpartum
asphyxia in particular. Tucker, Florey, Howie, Mcllwaine and Hall (1994) found the number,

10
timing, location and supervision of antenatal visit as the main pregnancy outcome measures in
a retrospective cohort study of case record of antenatal care. In New Zealand, Essek et al (1992)
also observed that late antenatal care attendance was associated with single marital status,
grand multiparity and young age as well as low socio-economic status, and low education level.

The purpose of this study is to investigate the factors that influence utilization of antenatal care
services in urban squatter settlement. The factors that influence the utilization of antenatal care
services are: Socio-demographic factors, Knowledge on antenatal care services, Accessibility.

2.1 Socio- Demographic factors and utilization of antenatal care services

The levels of antenatal care utilization were found to be high among women with higher
economic status, better education, few children, married women and employed women. In
another related research conducted in Nicaragua by Lubbak and Stephenson, (2008) on the
utilization of antenatal care services, the age of participants range from 18 – 40 with a mean
age of 26 years. The mean number of children per woman was 3.3. The overwhelming majority
of women interviewed sought antenatal care. The study also reveals the shared cultural belief
that a woman’s role is to be the caretaker of her children. Women’s acceptance of this
prescribed gender role as the passive caretaker of the family heightens the perceived
opportunity costs of seeking antenatal care. For women, prenatal care is considered necessary
primarily to ensure the health of a child rather than to protect one’s own health. There is a
disconnection in how women view antenatal care in relation to the health and security of their
child, which may result in the difference in their utilization of antenatal care services.

Older women are possibly more confident and influential in household decision-making than
younger women and, than adolescents in particular. Furthermore, older women may be told by
health workers to deliver in a facility since older age is a biological risk factor. On the other
hand, older women may belong to more traditional cohorts and thus be less likely to use modern
facilities than young women. (Gabrysch and Campbell, 2009) There are a number of published
and unpublished works that explore women’s experiences, views, and beliefs in relation to
delivery in Bangladesh. These studies have found a wide range of factors that may contribute
to low levels of use of professional services to delays in the decision to seek care, or to refusal
of referrals for service. It was found that women from low-income families were less likely to
seek prenatal care, visit the town health centre or local private clinic; whereas women from
high-income families used country hospitals or higher medical institutes which provided better
quality care. These findings led to the recommendation that low income should be taken as

11
“high-risk factor” for poor maternal health (World Bank, 1993) World Bank, (1993), states that
there has been no significant decline in poverty rates throughout most of the developing world
over the past decade. It is indicated that in developing countries the individual family is likely
to be impoverished with no resources for emergencies. When daily survival of the family is at
risk, mothers will use fewer resources for their own health. Moreover, most developing
countries spend less on health and welfare than they do on servicing their debts. Millions of
women cannot afford to use maternal health services. Even when formal fees are low or non-
existent women often face hidden fees and expenses for transport, drugs, and food. In Zaria,
Nigeria a study found that from free to fee-based services for obstetric care reduced admission
overall, but significantly increased emergency cases. The number of maternal death rose
correspondingly (Harrison, 1997). The poorer the women are the more likely fees are to affect
their use of health services.

Hadi, Rahman, Khuram, Ahmed and Alam, (2007), in their research on “the inaccessibility and
utilization of antenatal health care services in Balkh Province of Afghanistan”, the utilization
of Antenatal care (ANC) services was differentiated by the participation of women in activities.
The use of each of the ANC services was significantly lower among women who were involved
in economic activities than among those not economically active. This indicates that
involvement in such activities might have created extra burden on them and reduced the time
they had available for receiving such services. Again they said that age of the women appeared
to be negatively associated with the use of ANC. According to Matua (2004), as cited by
Chaibva S.N (2008), pregnant adolescents might shun ANC services for fear of being labelled
“promiscuous”. On the other hand, older adolescent who have had uneventful pregnancies and
deliveries with previous pregnancies might see no reason to attend ANC. In 19 out of 26
developing countries, women who were 19 years or younger were reportedly less likely than
older women to seek ANC from health professionals (Reynold et al 2006).

Illiteracy rates may be almost 50% higher for women than men UNESCO (1992) and women
without formal education have a greater risk of maternal mortality than educated women
(Harrison 1990 and Briggs 1993). Also, Franke and Chasin, (1992) state that although
education and social welfare are not aimed at only improving maternal health, increased
spending in these areas leads to sustained reduction in maternal mortality and morbidity. The
client’s level of education could also influence pregnant women’s utilization of the health
facilities as well as the understanding of the importance of seeking health care promptly. Low
educational status has been identified as a major barrier to the utilization of health care services

12
especially ANC. These women could easily be persuaded by their grandmothers or TBA’s not
to attend ANC and to deliver their babies at home. (Mottew 1997, cited by Mathole et al 2005).
Lack of education can also negatively affect the women’s comprehension of important
information and the ability to make informed decisions including the awareness of their own
rights (Matua 2004; Irinoye et al 2001) These findings imply that pregnant adolescents who
may have attained only low level education may not value utilizing ANC services. High
educational levels of both husband and wife have been observed to promote positive health
seeking behaviors according to Mulholland, Alibarnho, Brew-Graves and Monreal-Pinland
(1999) as well as Matha (2004). In Kausani, Kano State, Nigeria, according to Adamu and
Salihu (2002), most women deliver at home and a few receive ANC. The three most common
reasons given for non-use of ANC were limited financial resources, God’s will and husband
demand. In order to improve utilization of ANC services, efforts to relieve poverty, and
empower women economically are needed. Any programme must take into consideration this
socio cultural context of the population.

Cultural practices and traditional beliefs could be a negative factor contributing to ANC
services utilization. In Sudd, Southern Sudan, traditional practices in pregnancy and child birth
have been deeply rooted in the lives of the people that it conflicts with the acceptance of modern
antenatal care (Boudier, 1984). In Cameroun, one reason why women continue to seek care
from traditional midwives in spite of sufficient number of government maternity units is to
guarantee appropriate disposal of placenta, which plays a vital role in their culture (Coma,
1960).

Leslie and Gupta (1988) and Pelto (1987) in their studies revealed that cultural background of
women serves as an important factor in the utilization of maternal health services. The cultural
prospect on the use of maternal health services suggests medical need is determined not only
by the presence of physical disease, but also by cultural perception of illness (Addai 2000).

In many parts of Africa, women’s decision making power is extremely limited particularly in
matters of reproduction and sexuality. Decision making with regard to maternal care is often
made by husband or other family members (WHO 1998). In a study conducted in Nigeria, it
was found that in almost all cases, a husband’s permission is required for a woman to seek
health services, including lifesaving care. Men play a determining role in decision over when
to seek treatment, be it traditional or orthodox in many cultural contexts (Oxaal and Baden,
1996).

13
Marital Status could influence health care seeking behaviors. According to WHO (2003) cited
by Chaibva C.N (2008), unmarried pregnant women are less likely to seek ANC services due
to a lack of economic and social support from parents, guardians and spouses. Married pregnant
adolescents may also lack social independent and decision making powers to seek ANC. There
may be pressure or oppression from the spouse or influential members of the extended family
forcing pregnant women to accept the decision made on their behalf (WHO 2003).

2.2 Knowledge about Antenatal Care Services and Utilization of ANC services
Knowledge is a major structural variable that could influence the decision on whether to utilize
ANC services. Women need information about pregnancy and ANC services during their pre
conception period so that they can make informed decisions when pregnant. In Dundee,
Scotland, Florey and Taylor (1994) observed that the earlier in pregnancy the first antenatal
visit is made, the greater the infant birth weight. This relationship was independent of
gestational age of birth, mothers’ age and height, social class and the child’s sex.

Health education programmes during ANC services should inform the women about
reproductive health, knowledge related to sexuality, pregnancy, nutrition, family planning,
malaria, S.T.I’s, HIV/AIDS etc. (Barnet et al 2003; Lesser et al 2003). Information should
indicate where these services are offered, including the requirements for attending ANC.
Specific knowledge about the risks of childbirth and the benefits of skilled attendance should
increase preventive care-seeking, while recognition of danger signs and knowledge about
available beneficial interventions should increase care-seeking for complications. Inadequate
knowledge about ANC and its benefits to the mother’s and the infant’s health may also
negatively influence the utilization of ANC services. Sometimes, pregnant women may not be
aware of the health problems related to poor or no utilization of ANC services (Dennit et al
1995). Behavior is expected to change if pregnant women are aware of the implications of not
attending ANC and if they are convinced of the benefits of practicing preventive care.

Perceived benefits of utilizing ANC services provide a platform for interacting with the
pregnant women, identifying needs or problems and jointly arriving at possible solutions to
these needs. The pregnant women need to know the benefits of attending ANC as well as the
implications of not attending ANC. Pregnant women might value the importance of ANC if
they were aware of its benefits to their health and that of their babies. Adequate ANC utilization
implies that the initial ANC should take place before 16 weeks of gestation during the first
trimester of pregnancy with a minimum of four ANC visits during the pregnancy.

14
The second ANC visit should occur between 16 and 23 weeks gestation. The third ANC visit
takes place between 24 and 28 weeks gestation. The fourth ANC visit takes place between 32
and 34 weeks of gestation. The fifth ANC visit is conducted between 36 and 37 weeks, while
the sixth visit between 38 and 42 weeks respectively. However the ANC visits may be more
frequent when there are potential health risks. The ANC attendance register for 2004 and 2005
revealed that the majority of Zimbabwe’s pregnant women had an average of one ANC visit
before delivery and an initial ANC visit was made during the second or third trimester (Singh
and Khare2001).

2.3 Accessibility of ANC services and Utilization of ANC services

Access to ANC is important in helping to modify women’s risk behaviors and promote positive
health practices for adolescents of risk of future unplanned pregnancies and STI. Slap (1995).
Antenatal care services should be accessible to all pregnant women irrespective of social status,
age, race or level of education and HIV status, and should provide an environment of trust and
confidentiality. (Kluge, 2006) According to Kathyryn (1997) and Llongo (2004), the following
factors contribute to perceived inaccessibility of ANC services: Stigma and beliefs about social
rejection, Lack of confidentiality, Cultural beliefs and perceptions about ANC, Expensive
health care services and previous health care experiences.

The most important variable associated with utilization of MCH services is the physical
accessibility of these services (Abbas and Walker, 1986). Several other studies also found that
physical proximity of health care services, especially in the developing countries, plays an
important role in utilization of these services (Stock, 1983; Airey, 1989; Paul, 1991) The
majority of maternal deaths occur during labor, delivery, and the immediate postpartum period
(Wanjira,Mwangi, Mathenge,Mbugua and Ng’ang’a 2011). Because most maternal deaths
occur due to preventable obstetric complications, most could be prevented if women had access
to high-quality maternal health care, including antenatal care, skilled assistance at delivery, and
postnatal care (Chou, Inoue, Mathers, Oestergaard, Say, Mills, Suzuki, and Wilmoth 2010).

The majority of pregnant women might not be able to afford the maternity fees that are charged
because most of them have financial limitations. In Zimbabwe, the government tries to assist
those pregnant women who genuinely cannot afford to pay by referring them to social welfare.
However the process of obtaining state assistance by pregnant women who genuinely cannot
afford to pay is long and frustrating causing mothers to shun social welfare. The perceived high
fees might influence some pregnant women to resort to the services of traditional birth

15
attendants (TBAs) which are cheaper and can be paid in kind (Ikamari 2004). Reynolds in
(2006) cited socio-economic factors contributing to poor ANC attendance and thus also to poor
maternal and neonatal outcomes.

In Ghana before 2006, pregnant women were charged maternity fees which differ with each
health institution. From 2006, with the advent of National Health Insurance Scheme (NHIS),
any pregnant woman who has registered with the scheme is exempted from paying. However,
on 1st July, 2008, the government of Ghana in order to reduce the maternal mortality which
was high made antenatal and delivery free of charge. Pregnant women would be motivated to
use the ANC services if they are acceptable and need focused without restrictions.

Pregnant women expect care that is acceptable and focuses on their individual needs. ANC
services should be available to pregnant women without any restrictions. In Ghana, ANC is
provided at every health centre/hospital and it is clear that its availability is acceptable to
pregnant women.

The effectiveness of ANC has provoked much debate about its usefulness because little is
known about its effectiveness in the reduction of maternal and infant mortality and morbidity
(Carrole et al 2001). Despite all these reservations, ANC in developing countries is important
especially to pregnant women. Efficacy of ANC should also ensure dissemination of
information on maintaining good health of pregnancy, danger signs and when and where to go
for help should these appear (Yuster 1995). The goal-oriented ANC guidelines using need
focused care have been designed to address aspect of quality, adequacy and effectiveness.

2.4 Research gap

The literature review looked at the literature on the various factors that influence utilization of
antenatal care services in urban squatter settlements which included; Socio-demographic
factors, Knowledge about ANC services, Accessibility of the ANC and the Quality of services
rendered at the ANC.A study done by Ejik, Bles, Odhiambo, Ayisi, Blokland and Rossen
(2006), in Asembo and Gem, they found out that the usage of the ANC was high, but this
opportunity to deliver important health services was not fully utilized. Use of professional
delivery services was low, and almost 1 out of 5 women delivered unassisted. They further
suggested that there is an urgent need to improve this dangerous situation.

From it, it is evident that various studies have made attempts to address a myriad of factors
that influence the utilization of antenatal care services in different countries. In trying to do so,

16
we can see that the said factors are correlated but we do not clearly see the extent to which
these factors influence the utilization of Antenatal Care services; therefore this study tried to
address this void.

2.5 Conceptual Framework

The conceptual framework in figure 1 shows the relationship between the dependant and the
independent variables. It provides abstract basis for thinking about what we do and about what
it means, it is influenced by the ideas and research of others. In this regard, it forms an overview
of ideas and practices that shape the way this study will be done. In this framework four major
factors were presented as the main factors that contribute to utilization and satisfaction with
Antenatal Care Services (ANC). These were: Socio-economic and demographic factors,
Knowledge on Antenatal Care Services, Accessibility of the ANC all these three factors were
interrelated in a way and determined whether a woman could utilize and be satisfied with
Antenatal Care Services.

The dependant variable in this study will be the utilization of antenatal care services. Utilization
of antenatal care services is influenced by several factors that constitute the independent
variables. Based on the literature review, the factors that influence the utilization of ANC
services includes Socio-demographic factors, Knowledge about ANC services, and
Accessibility The moderating variables, which according to Kothari (2004) are independent
variables that are not related to the purpose of the study but can have an effect on the dependent
variable, in this study will be the government policy while the intervening variable which is a
variable that explains a relation or provides a causal link between other variables, will be the
cultural beliefs.

17
 Independent variables Dependent variable

Socio Demographic Factors

 Age
 Occupation
 Level of Education
 Marital status
 Religion
 Income Level

Knowledge on Antenatal Care

 Awareness on Risks and UTILIZATION OF

benefits of ANC
ANTENATAL CARE
 Time of first visits
(Initiation) SERVICES
 Number of visits

Accessibility

 Availability
 Costs of tests,
screening, drugs
 Distance to facility
 Mode of Transport

18
 CHAPTER THREE
METHODOLOGY

3.0 Introduction
This chapter presents the methodology that will use in the study. It begins with a description
of the research design, research population, Study Area, Inclusion and Exclusion criteria, study
sample, sampling procedure, research instruments for data collection, data analyze, limitations
during over all research processes and ethical consideration.

3.1 Research Design

This study was used descriptive research design that will describe Factors affecting utilization
of antenatal care services among women childbearing age in Wardi health Center in
Mogadishu-Somalia.

3.2 Research Population

The study population was women of child bearing age in 17 districts of Mogadishu Somalia.
Therefore, the target population of the study will be (70) respondents consist of anyone in those
attending Waridi. So that, the study population was employees in health centers, mothers,
national and international NGO employees.

3.3 Study Area

The study area of this study was Wardi Xamar Jabjab District in Mogadishu -Somalia.

3.4 Inclusion and Exclusion criteria

3.4.1 Inclusion criteria
Women of childbearing age live in Banadir region of Somalia
3.4.2 Exclusion criteria
Non- child bearing women live in Banadir region of Somalia

3.5 Sample size determination

The estimation of sample size was based on estimated the prevalence of tetanus with children
under five years and their mothers in Warta Nabada. The sample size designed was 60 of
tetanus children under five years. The sample size was distributed among four health centers
in Warta Nabada. The sample size was categorized as 30 of them generalized tetanus 20 was
localized tetanus the last 10 were both. If the sample is selected properly, the information

19
about the sample was used to make statement about the whole population therefore the
research measured the sample of 40 respondents sufficient to determine the outcome of the
study.

The study was used Slovene’s formula which is

n= N/ [1+ (N*e^2)],
Where; n=sample size,
N=population size 70 and,
e= margin of error of 5%.
n=70/ [1+ (70*0.0025)] = 60

3.6 Sampling Procedure

Probability sampling method especially simple random sampling procedure was used to
select respondents of this study.

3.7 Data Collection Method

Questionnaires were used to collect quantitative data from the respondents.
A questionnaire is an instrument that contains questions aimed at obtaining specific
information on a variety of topics (Kombo and Tromp, 2006). The quantitative method
through the use of questionnaire facilitated exploring the views of a large number of
respondents in a short period of time (Bryman, 2012).

3.8 Data Analysis

Neuman (2006:322) explains data analysis as a technique for gathering and analyzing the
content of the text. It also refers to words, meanings, pictures, symbols, ideas, themes or any
message that can be communicated. Data analysis was carried out using the Statistical Package
of Social Sciences [SPSS] software. Descriptive statistics, that is, means and standard deviation
were worked out and presented using frequencies, percentages and cross tables. The mean was
used because it took into account each score in the distribution and it was more stable than the
median and mode, (Mugenda and Mugenda, 1999). Standard deviation was advantageous
because it responded to the exact position of every score relative to the mean of that distribution
and it was sensitive to extreme scores, (Mugenda and Mugenda, 1999). Frequency distribution
tables were used because they enable the reader to see the trend of the distribution more easily
by simply looking at numbers in the table.

20
3.9 Research Quality
Research quality tells about validity and reliability as follows:
3.9.1 Validity
Validity in research refers to whether the research method measures what it intends to measure
(Denscombe, 2010). The integrity of the findings/conclusion from the research is the main
concern of the validity (Bryman, 2012). So we will collect information that is free from any
bias from the respondents.
3.9.2 Reliability
Whether the research tools can be replicated and whether they produce the same results
repeatedly under similar conditions is called reliability (Denscombe, 2010). So we will use
checked questionnaire by expects and supervisor.

3.10 Limitations
I believe that the most significant limitation that I was faced is the lack of library books
concerned with the effect of occupational hazards on workplaces. Perhaps some of the
respondents in Hotels, Restaurants and Schools are never been work questionnaire that can
result misunderstand. The time was limited in a short duration.

3.11 Ethical Considerations

The study took into account all possible and potential ethical issues. The measures undertaken
to ensure compliance with ethical issues included keeping the identity of respondents
confidential. Wimmer and Dominick (1994) identify the principle of confidentiality and respect
as the most important ethical issues requiring compliance on the part of the researcher. The
basic ethical requirements demand that the researcher respects the rights, values and decisions
of respondents. In this study, the values of the respondents were given due respect. Using the
research, respondents’ responses were neither interfered with nor contested by the researcher.

21
 CHAPTER FOUR
DATA ANALYSIS AND INTERPETATION

4.0 Introduction
In this chapter data will be presented, analyzed and interprets. The data from the respondents.
This based on the research objective. I collected from the health workers in the district
including
auxiliaries, nurses, lab technician and physician in the health centers in the district. Frequency
charts.

22
Table 4.1 Respondent by Gender
Frequency Percent

71.2
Male
20
28.8
Female 40

Total 60 100.0

Table 4.1 shows that the findings of the study indicated the majority of the respondents were
male’ represented by 40(71.2%) while Female’ respondents were 20 (28.8%)

Figure 4.1
Male Female Total

17%

50%

33%

23
Table 4.2 Respondent by age
Frequency Percent
18-25 25 55.2
26-35 20 20.9
36-45 10 14.9

46-60 5 9

Total 60 100.0

Table 4.2 shows that the findings of the study indicated the majority of the respondents were
18-25 years old 25 (55.2%), next age group was between 26- 35 years old which accounts as
20 (20.9%), and the minor group were 36-45 years old which is equivalent 10 (14.9%)
respectively then 46-60 years old which was 5 (9%).

Figure 4.2
Frequency Percent

20.9
14.9 9 100
55.2

20
10 5 60
25

18-25 26-35 36-45 46-60 Total

24
Table 4. 3. Marital Status
Frequency Percent

Single 15 25.7

Married 35 50.4

Widow 10 15.4

Divorced 5 8.5

Total 60 100

Table 4.3 indicate the majority of the respondent Married 35 (50.4%) were respondents while
the respondent Single 15 (25.7%) were the respondents Widow 10 (15.4%) and were the
respondents Divorced 5 (8.5%).

Figure 4.3

100%
90%
80%
70%
60%
50% Percent
40% Frequency
30%
20%
10%
0%
Single
Married Widow Divorced Total

25
Table 4.4 level of occupation

Frequency Percent

Manual work 20 38.7

Unemployed 35 50.4

House wife 10 10.9

Total 60 100

Table 4.4 shows that most of the respondents were Unemployed 35 (50.4%) while the
respondent Manual work 20 (38.7%) while the minority of respondent was House wife 10
(10.9%).

Figure 4.4

Total

House wife

Frequency
Percent
Unemployed

Manual work

0% 20% 40% 60% 80% 100%

26
Table 4.5 Level of education
Frequency Percent
Primary 10 10.4
Secondary 15 25.4
University 35 64.2
Total 60 100.0

Table 4.5 shows that most of the respondents were University 35 (64.2%). where respondents
15 (25.4%) were Secondary some of the respondents Primary 10 (10.4%).

Figure 4.5

100%
90%
80%
70%
60%
50% Percent
40% Frequency
30%
20%
10%
0%
Total
Primary Secondary University

27
Table 4.6 How did you hear about Antenatal Care Services?
Frequency Percent
Relatives 15 25.4
During a visit 35 64.2
Social media 10 10.4
Total 60 100.0

Table 4.6 shows that most of the respondents were During a visit 35 (64.2%). where
respondents 15 (25.4%) were Relatives some of the respondents Social media 10 (10.4%).

Figure 4.6
180
160
140
120
100
Percent
80
Frequency
60
40
20
0
Relatives During a Social Total
visit media

28
Table 4.7 In your view when should pregnant women access Antenatal Care Services?
Frequency Percent
1st Trimester 40 75.4
2nd Trimester 15 15.2
3 rd Trimester 5 9.4
Total 60 100.0

Table 4.7 shows that most of the respondents were 1st Trimester 40 (75.4%). where
respondents 15 (15.2%) were 2st Trimester some of the respondents 3st Trimester 5 (9.4%).

Figure 4.7

Total

3 rd Trimester
Frequency
Percent
2nd Trimester

1st Trimester

0% 20% 40% 60% 80% 100%

29
Table 4.8 How many visits should a pregnant make to the Antenatal Care Services
during the entire period of pregnancy?
Frequency Percent
Only one time 6 9
Twice 15 20.9
Thrice 10 14.9

Four times 30 55.2

Total 60 100.0

Table 4.8 shows that the findings of the study indicated the majority of the respondents were
Four times 30 (55.2%), next age group was between Twice which accounts as 15 (20.9%),
and the minor group were Thrice which is equivalent 10 (14.9%) respectively then Only one
time which was 6 (9%).

Figure 4.8
100%
90%
80%
70%
60%
50% Percent
40%
Frequency
30%
20%
10%
0%
Only Four Total
one time Twice Thrice
times

30
Table 4.9 Is the Antenatal Care Service accessible?

Frequency Percent

91.7
Yes 55

8.3
No 5

Total 60 100.0

Table 4.9 indicate the majority of the respondent 55 (91.7%) were mentioned Yes while the
respondent 5 (8.3%) were mentioned No.

Figure 4.9

Yes No Total

46%
50%

4%

31
Table 4.10 What means of transport do you use when accessing Antenatal Care
Services?

Frequency Percent

44.8
Walk 25

55.2
Public means 35

Total 60 100.0

Table 4.10 indicate the majority of the respondent 35 (55.2%) were mentioned Public means
while the respondent 25 (44.8%) is Walk.

Figure 4.10
Frequency Percent

Total 60

Public means 35

Walk 25

32
Table 4. 11. How much do you pay for transport to and from the services?

Frequency Percent

Nothing 15 25.7

Between 20-40 35 50.4

Between 41-60 10 15.4

Above 60 5 8.5

Total 60 100

Table 4.11 indicate the majority of the respondent Between 20-40 35 (50.4%) were
respondents while the respondent Nothing 15 (25.7%) were the respondents Between 41-60
10 (15.4%) and were the respondents Above 60 5 (8.5%).

Figure 4.11
Frequency Percent

25.7 50.4 15.4 8.5 100

15 35 10 5 60

Nothing
Between 20-40 Between 41-60 Above 60 Total

33
Table 4.12 Do you pay for the Antenatal Care Services?
Frequency Percent

91.7
Yes 55

8.3
No 5

Total 60 100.0

Table 4.12 indicate the majority of the respondent 55 (91.7%) were mentioned Yes while the
respondent 5 (8.3%) were mentioned No.

Figure 4.12
Frequency Percent
180
160
140
120
100
80
60
40
20
0
Yes No Total

34
Table 4. 13 If yes, how much?

Frequency Percent

Between 0 -50 15 25.7

Between 51-100 25 15.4

Between 101-150 15 50.4

Over 151 5 8.5

Total 60 100

Table 4.13 indicates the majority of the respondent Between 101-150. 25 (50.4%) were
respondents while the respondent Between 0-50, 15 (25.7%) were the respondents Between
51-100, 15 (15.4%) and were the respondents Over 151, 5 (8.5%).

Figure 4.13
Frequency Percent

15.4
25.7 8.5 100
50.4

25
15 5 60
15

Between 0 -
50
Between 51- Between Over 151 Total
100 101-150

35
Table 4.14 Do you access Antenatal care services during all your pregnancies?

Frequency Percent

91.7
Yes 55

8.3
No 5

Total 60 100.0

Table 4.14 indicate the majority of the respondent 55 (91.7%) were mentioned Yes while the
respondent 5 (8.3%) were mentioned No.

Figure 4.14
Frequency Percent
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Yes No Total

36
Table 4.15 Where do you attend Antenatal Care Clinics?

Frequency Percent

Government hospital 20 38.7

Private hospital 35 50.4

Traditional 5 10.9

Total 60 100

Table 4.15 shows that most of the respondents were Private hospital 35 (50.4%) while the
respondent Government hospital 20 (38.7%) while the minority of respondent was
Traditional 5 (10.9%).

Figure 4.15
Frequency Percent

Total 60 100

Traditional 5 10.9

Private hospital 35 50.4

Government hospital 20 38.7

37
Table 4.16 How many people attend to you when you access Antenatal
Care Services at the clinic?
Frequency Percent

1-2people 20 38.7

3-4 35 50.4

Above 5 5 10.9

Total 60 100

Table 4.16 shows that most of the respondents were 3-4, 35 (50.4%) while the respondent 1-
2people 20 (38.7%) while the minority of respondent was Above 5, 5 (10.9%).

Figure 4.16
Frequency Percent

100

50.4
38.7
60
35
20 10.9
5
1-2people 4-Mar Above 5 Total

38
Table 4. 17. How would you rate the attitude of service providers towards
pregnant women?
Frequency Percent

Very poor 2 3.5

Poor 3 5.4

Good 40 65.4

Very good 15 25.7

Total 60 100

Table 4.17 indicates the majority of the respondent Good 40 (65.4%) was respondents while
the respondent Very good 15 (25.7%) were the respondents Poor 3 (5.4%) and was the
respondents Very poor 2 (3.5%).

Figure 4.17
Frequency Percent

3.5 5.4 65.4 25.7 100

2 3 40 15 60

Very poor
Poor Good Very good Total

39
Table 4.18 Are you always referred in case of health problem?
Frequency Percent

8.3
Yes 5

91.7
No 55

Total 60 100.0

Table 4.18 indicate the majority of the respondent 55 (91.7%) were mentioned No while the
respondent 5 (8.3%) were mentioned Yes.

Figure 4.18
180
160
140
120
100
Percent
80
Frequency
60
40
20
0
Yes No Total

40
Table 4. 19 How long does it take to access Antenatal Care
Service?

Frequency Percent

Between 1 – 20
minutes 50 83.5

20 – 40 minutes 5 8.1

40 – 60 minutes 3 5.4

Over 60 minutes 2 3.5

Total 60 100

Table 4.19 indicates the majority of the respondent Between 1 – 20 minutes 50 (83.5%) was
respondents while the respondent 20 – 40 minutes 5 (8.1%) were the respondents 40 – 60
minutes 3 (5.4%) and was the respondents Over 60 minutes 2 (3.5%).

Figure 4.19
Frequency Percent

83.5 8.1 5.4 3.5 100

50 5 3 2 60

Between 1 – 20
minutes
20 – 40 minutes 40 – 60 minutes Over 60 minutes Total

41
Table 4. 20 Are you satisfied with the Antenatal Care Services rendered?
Which number rates your satisfaction?
Frequency Percent

Very poor 2 3.5

Poor 3 5.4

Good 40 65.4

Very good 15 25.7

Total 60 100

Table 4.20 indicates the majority of the respondent Good 40 (65.4%) was respondents while
the respondent Very good 15 (25.7%) were the respondents Poor 3 (5.4%) and was the
respondents Very poor 2 (3.5%).

Figure 4.20
Frequency Percent

3.5 5.4 65.4 25.7 100

2 3 40 15 60

Very poor
Poor Good Very good Total

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 CHAPTER FIVE
CONCLUSION AND RECOMMENDATION

5.0 Introduction
In this chapter will contain introduction, findings, conclusion and recommendation.

5.1 Findings
The findings of the study indicated the majority of the respondents were male’ represented by
40(71.2%) while Female’ respondents were 20 (28.8%) the findings of the study indicated the
majority of the respondents were 18-25 years old 25 (55.2%), next age group was between 26-
35 years old which accounts as 20 (20.9%), and the minor group were 36-45 years old which
is equivalent 10 (14.9%) respectively then 46-60 years old which was 5 (9%) the majority of
the respondent Married 35 (50.4%) were respondents while the respondent Single 15 (25.7%)
were the respondents Widow 10 (15.4%) and were the respondents Divorced 5 (8.5%). most
of the respondents were Unemployed 35 (50.4%) while the respondent Manual work 20
(38.7%) while the minority of respondent was House wife 10 (10.9%). that most of the
respondents were University 35 (64.2%). where respondents 15 (25.4%) were Secondary some
of the respondents Primary 10 (10.4%). that most of the respondents were During a visit 35
(64.2%). where respondents 15 (25.4%) were Relatives some of the respondents Social media
10 (10.4%). most of the respondents were 1st Trimester 40 (75.4%). where respondents 15
(15.2%) were 2st Trimester some of the respondents 3st Trimester 5 (9.4%). the findings of the
study indicated the majority of the respondents were Four times 30 (55.2%), next age group
was between Twice which accounts as 15 (20.9%), and the minor group were Thrice which
is equivalent 10 (14.9%) respectively then Only one time which was 6 (9%). the majority of
the respondent 55 (91.7%) were mentioned Yes while the respondent 5 (8.3%) were mentioned
No. the majority of the respondent 35 (55.2%) were mentioned Public means while the
respondent 25 (44.8%) is Walk. the majority of the respondent Between 20-40 35 (50.4%)
were respondents while the respondent Nothing 15 (25.7%) were the respondents Between 41-
60 10 (15.4%) and were the respondents Above 60 5 (8.5%). the majority of the respondent
55 (91.7%) were mentioned Yes while the respondent 5 (8.3%) were mentioned No. the
majority of the respondent Between 101-150. 25 (50.4%) were respondents while the
respondent Between 0-50, 15 (25.7%) were the respondents Between 51-100, 15 (15.4%) and
were the respondents Over 151, 5 (8.5%). the majority of the respondent 55 (91.7%) were
mentioned Yes while the respondent 5 (8.3%) were mentioned No. most of the respondents

43
were Private hospital 35 (50.4%) while the respondent Government hospital 20 (38.7%) while
the minority of respondent was Traditional 5 (10.9%). most of the respondents were 3-4, 35
(50.4%) while the respondent 1-2people 20 (38.7%) while the minority of respondent was
Above 5, 5 (10.9%). the majority of the respondent Good 40 (65.4%) was respondents while
the respondent Very good 15 (25.7%) were the respondents Poor 3 (5.4%) and was the
respondents Very poor 2 (3.5%). the majority of the respondent 55 (91.7%) were mentioned
No while the respondent 5 (8.3%) were mentioned Yes. the majority of the respondent Between
1 – 20 minutes 50 (83.5%) was respondents while the respondent 20 – 40 minutes 5 (8.1%)
were the respondents 40 – 60 minutes 3 (5.4%) and was the respondents Over 60 minutes 2
(3.5%). the majority of the respondent Good 40 (65.4%) was respondents while the respondent
Very good 15 (25.7%) were the respondents Poor 3 (5.4%) and was the respondents Very poor
2 (3.5%).

5.2 Conclusion
The study findings indicated that almost all the mothers who were took part in the study had
attended some level of school. This indicates that literacy has a part to play in determining
whether a mother will utilize maternal and child health services or not. This is because they
can read the Information, Education and Communication (IEC) materials displayed in public
places encouraging mothers to seek ANC care.
Study discovered that health care workers’ attitude is an important consideration if we want to
improve the uptake of ANC services. The explanations given by respondents were that bad
attitude by health care workers towards clients will discourage them from coming for the
services.
Waiting time had influence on utilization of ANC services while more than a third of the
respondents pointed that long waiting time discourages clients from coming for the services
since it wastes their valuable time. This means that if the waiting time for services is usually
long in the hospital, uptake of ANC services will be low.
60.9% of the respondents prefer private facility than the public hospitals; it may be the quality
of health service provision.
Most of the respondents were getting permission from husband (decision maker) when
attending ANC, then The question as to whether husband accompany to the ANC was asked
and 206 (80.5) respondents responded to “No” that husband doesn’t accompany to ANC
checkups

44
Most of the respondents rated some of the services including delivery and cesarean section an
expensive, this is because the economic activity may determine whether a mother will get
money during pregnancy to seek the services.

5.3 Recommendations
Based on the findings, this study recommends:
1) This study recommends development of policies and public health programs focusing
on increased awareness and behavioral change among pregnant women attending health
centers to receive antenatal care services as well as other high risk groups in the
population
2) Health promotion of family planning/ birth spacing through mass media. Poster and
health education in MCH facility to promote family /birth spacing uptake
3) IYCF counseling session during NAC visit and postnatal check
4) Health seeking behavior activity to reduce still birth and abortion
5) Capacity building of health professional of behavior change communication massages,
6) Expanding of primary health care services and health system strengthen though
resource allocation and supportive supervision.
7) Improve public health services by improve quality of health care services in the public
Maternal and child health services
8) Improving male involvement of reproductive health services through male to male
Interpersonal communication agents,
9) Government engagement of free health services or cost sharing mechanism.
10) Ministry of health development should implement research library to keep written
documents or researches done before in order to improve data about maternal and child
health which help researchers to use as reference.

45
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