Factors affecting mothers' utilization of maternal services in Kibale District
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A dissertation submitted in partial fulfillment of the requirements for the award of the degree of Master of Arts in Women Studies of Makerere University
This report presents findings from a study entitled "Factors affecting Mothers' Utilization of maternal services in Kibale District". Studies carried out earlier in this district indicated that the use of Antenatal care (ANC) services was as low as 32% (Balinda, 1991). Given the importance of ANC in the promotion of maternal and child survival, this study attempted to find out the factors which were responsible for the low user rates. The study also attempted to establish why some women attended. A community based study was carried out. Ninety mothers who had a child in the two years proceeding the study were interviewed. The major findings of the study were:- (1) Ninety five (95%) had received ANC services at least once in the last pregnancy, 5% did not attempt to seek ANC services (2) Although the majority of the women reported having received ANC services once, many did not attend as is medically recommended in terms of time of booking and the frequency of visiting. While mothers are expected to start as early as possible (between 1st and 3rd times) only 14% of the mothers were able to start within this period, 81% started attending 4th-6th, 5% started between the 7th and 9th months of gestation. Furthermore, mothers are expected to make a minimum of five visits during the course of pregnancy. The majority of mothers (78%) made less than four visits, while only 22% made the recommended number of visits. The period when a mother is booked and the frequency of visits made during the course of pregnancy is important in ANC delivery services, so further analysis was made to find out mothers who booked early, and made enough (at least five) with an effort to establish the quality of utilization of ANC services by mothers. It was found out that 36% of the mothers utilized the services adequately, ie. they were booked between 1st and 3rd months of pregnancy, and they made five visits. (3) The factors which were found to be associated with non-utilization and inadequate utilization were: i) Long distance between mothers' home and ANC centre. The mean distance travelled to the health centre was 6.25 km. Indeed mothers who were living nearer attended more frequently than whose who were living far. All (100%) mothers who were living 5 km from the ANC utilized the services, while 92% of those who were living beyond 5 km did so. In case of mothers who stay away from the health centre, non attendance was aggravated by lack of bicycle and sickness. In-depth interview with women who did not make enough visits, established that mothers could not make enough enough visits because they were sick. This is an expected response which should be noted. Women should not regard ANC for curative purposes, but for preventive and detection of conditions which may be harmful to the mother and baby. ii) Another constraining factor to the utilization of ANC services were the individual determinants, notably education. The more educated a mother was the more likely it was for her to use the health services. A high proportion (48%) of those with secondary education women made five visits as compared to 18% of the now/primary of the educated women. iii) The health status of the mother: Many mothers were not booked early because they had no health problems, 50% were booked late because they had no complaint. This indicates limited knowledge of purpose of ANC particularly the clinical importance of early booking. iv) Dissatisfaction with the quality of care. Only 54% were not satisfied with the services. From indepth interviews, it was established that this dissatisfaction affected subsequent visits. It reduced on the number of visits during the subsequent pregnancy. Some travelled longer distances for better quality ANC. (4) Generally women had a positive attitude towards ANC. 98% agreed that they had to attend ANC when they were pregnant. No cultural factors were found to be associated with non or poor utilization. From the above the following issued need to be addressed at policy level. i. Health education should be structured. This should address the knowledge gaps it when to book ANC services, and why and how frequent they should use the services. ii. There is need to introduce alternative services which are accessible and acceptable. This could be done by the MOH, emulating the strategies by safe motherhood of training pregnant monitors who examine, monitor women when they are pregnant, then refer them to health centres if necessary. iii. There is need to strengthen the TBA health care system. iv. Elimination of mass illiteracy should be given high priority.
This report presents findings from a study entitled "Factors affecting Mothers' Utilization of maternal services in Kibale District". Studies carried out earlier in this district indicated that the use of Antenatal care (ANC) services was as low as 32% (Balinda, 1991). Given the importance of ANC in the promotion of maternal and child survival, this study attempted to find out the factors which were responsible for the low user rates. The study also attempted to establish why some women attended. A community based study was carried out. Ninety mothers who had a child in the two years proceeding the study were interviewed. The major findings of the study were:- (1) Ninety five (95%) had received ANC services at least once in the last pregnancy, 5% did not attempt to seek ANC services (2) Although the majority of the women reported having received ANC services once, many did not attend as is medically recommended in terms of time of booking and the frequency of visiting. While mothers are expected to start as early as possible (between 1st and 3rd times) only 14% of the mothers were able to start within this period, 81% started attending 4th-6th, 5% started between the 7th and 9th months of gestation. Furthermore, mothers are expected to make a minimum of five visits during the course of pregnancy. The majority of mothers (78%) made less than four visits, while only 22% made the recommended number of visits. The period when a mother is booked and the frequency of visits made during the course of pregnancy is important in ANC delivery services, so further analysis was made to find out mothers who booked early, and made enough (at least five) with an effort to establish the quality of utilization of ANC services by mothers. It was found out that 36% of the mothers utilized the services adequately, ie. they were booked between 1st and 3rd months of pregnancy, and they made five visits. (3) The factors which were found to be associated with non-utilization and inadequate utilization were: i) Long distance between mothers' home and ANC centre. The mean distance travelled to the health centre was 6.25 km. Indeed mothers who were living nearer attended more frequently than whose who were living far. All (100%) mothers who were living 5 km from the ANC utilized the services, while 92% of those who were living beyond 5 km did so. In case of mothers who stay away from the health centre, non attendance was aggravated by lack of bicycle and sickness. In-depth interview with women who did not make enough visits, established that mothers could not make enough enough visits because they were sick. This is an expected response which should be noted. Women should not regard ANC for curative purposes, but for preventive and detection of conditions which may be harmful to the mother and baby. ii) Another constraining factor to the utilization of ANC services were the individual determinants, notably education. The more educated a mother was the more likely it was for her to use the health services. A high proportion (48%) of those with secondary education women made five visits as compared to 18% of the now/primary of the educated women. iii) The health status of the mother: Many mothers were not booked early because they had no health problems, 50% were booked late because they had no complaint. This indicates limited knowledge of purpose of ANC particularly the clinical importance of early booking. iv) Dissatisfaction with the quality of care. Only 54% were not satisfied with the services. From indepth interviews, it was established that this dissatisfaction affected subsequent visits. It reduced on the number of visits during the subsequent pregnancy. Some travelled longer distances for better quality ANC. (4) Generally women had a positive attitude towards ANC. 98% agreed that they had to attend ANC when they were pregnant. No cultural factors were found to be associated with non or poor utilization. From the above the following issued need to be addressed at policy level. i. Health education should be structured. This should address the knowledge gaps it when to book ANC services, and why and how frequent they should use the services. ii. There is need to introduce alternative services which are accessible and acceptable. This could be done by the MOH, emulating the strategies by safe motherhood of training pregnant monitors who examine, monitor women when they are pregnant, then refer them to health centres if necessary. iii. There is need to strengthen the TBA health care system. iv. Elimination of mass illiteracy should be given high priority.
Keywords
Maternal services, Maternal care, Mothers Kibale District - Uganda Antenatal care