Abstract

This study examined determinants of ANC utilization among pregnant women in the Buea Health District. Guided by specific objectives, the research sought to assess the level of awareness of ANC, evaluate attitudes toward its use, and identify the key challenges impeding access.

A cross-sectional descriptive design was employed, utilizing structured questionnaires to collect data from a purposively selected sample of pregnant women attending healthcare facilities. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative insights were used to complement and deepen interpretation of the findings.

The results revealed that although a majority of respondents demonstrated moderate knowledge of ANC and generally positive attitudes, significant barriers persisted. These included economic hardship, limited access to health facilities, sociocultural constraints, and perceived low quality of care. The findings underscore a critical gap between awareness and actual utilization of ANC services, suggesting that knowledge alone does not necessarily translate into consistent service uptake.

The study concludes that addressing structural, economic, and socio-cultural barriers is essential to improving ANC coverage and maternal health outcomes. It recommends a multi-sectoral approach involving government agencies, healthcare providers, community leaders, and the women themselves to enhance access, education, and quality of antenatal care. Future research should explore longitudinal patterns of ANC behavior and assess the impact of targeted interventions across diverse populations.

Keywords: Antenatal Care (ANC), Maternal Health, Knowledge, Attitudes, Barriers, Healthcare Utilization,

CHAPTER ONE

INTRODUCTION

1. 1  Background of the study

Antenatal care (ANC) is the care provided by skilled health-care professionals to pregnant women and adolescent girls in order to ensure the best health condition for both mother and baby during pregnancy. The components of ANC include; risk identification, prevention and management of pregnancy-related diseases; and health education and health promotion.  Globally, the maternal mortality rate (MMR) fell by nearly 44% over the past 25 years, to an estimated 216 maternal deaths per 100,000 live births in 2015.

Developing regions accounted for approximately 99% (302,000) of this estimated global maternal deaths in 2015, with sub-Saharan Africa alone accounting for roughly 66% (201,000).  This 2017 reports estimates MMR in Cameroon at 529 maternal deaths per 100,000 live births. ANC is very important in our society as it helps reduce maternal and perinatal morbidity through detecting and treating pregnancy related complications, early detection of possible risk factors which will compromise the pregnancy, thus ensuring referral to an adequate level of care .

ANC reduces the maternal and perinatal morbidity and mortality directly, by detection and treatment of pregnancy-related complications, and indirectly, by identification of women and girls who are at increased risk of developing complications during labour or delivery, so that appropriate referrals can be done. In 2015, countries met and put forth series of goals known as sustainable development goals (SDGs). These SDGs were aimed at reducing  global maternal mortality to less than 70 deaths per 100000 live births by 2030, with no individual country exceeding a MMR of 140 maternal deaths per 100000 live birth.

This global reduction of MMR and a positive pregnancy outcome can only be attained if the care delivered to women during pregnancy improve and they initiates antenatal care (ANC) early enough. In 2016, a new guideline of WHO recommends a minimum of eight ANC contacts during pregnancy and that the first contact should be done before the 12^th week of gestation . WHO defines late ANC as beginning ANC contact after 12 weeks of gestation . A study done in the USA showed that, adolescents aged 15 years or younger had higher risks for maternal death, early neonatal death, and anemia compared with women aged 20 to 24 years.

Moreover, all age groups of adolescents had higher risks for postpartum hemorrhage, puerperal endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for-gestational-age infants . Maternal mortality is the health indicator that shows the greatest differential between developing and industrialized countries.

Existing evidences have shown that in developing countries few women seek ANC services early in the course of pregnancy . Some of the factors, which are associated to late commencement of ANC in our setting, are maternal education, unemployment, lack of knowledge or misconceptions about the value/purpose of antenatal care, marital status, socioeconomic status and financial constraints.

According to a report from Cameroon Demographic and Health survey (CDHS) 2018, only 41% of women had their first ANC visit in the first trimester, but this still marks an increase from only 34% in 2011. A study carried by Halle et al. reported a similar prevalence of 27.2% first ANC visit in the first trimester in a health Centre in Buea.

1.2 Problem Statement

According to a report by WHO in 2019, the main factors that stood as a barrier for women seeking Antenatal care were; poverty, distance to facilities, lack of information, inadequate and poor quality services and cultural believes and practices. Despite several efforts to reduce maternal mortality, maternal deaths remain high globally, particularly in low and middle-income countries (LMIC) .

Sub-Saharan Africa has the highest mortality or morbidity due to reproductive ill-health among pregnant women. Despite this high level of antenatal care coverage in Cameroon so many women still lack access to appropriate pregnancy care, so they still die as a result of pregnancy and/or delivery related causes.

According to a study carried out in 2014 by G. E. Halle-Ekane et al, in Cameroon very few community-based surveys has been carried out on Antenatal care utilization. Also very little has been done to determine the impact of socio-economic factors on ANC attendance.  During my internship at the Mount Mary hospital Buea, I witnessed some cases of women not being able to attend ANC due to several reasons such as distance from the hospital, inadequate knowledge on ANC, poverty making some women not being able to do some of their test and ecography which is necessary for them.

1.3 Rational/Justification

In order to improve health, barriers that will limit the utilization of quality ANC services must be identified and addressed at both health system and societal level. This study will provide relevant data on the impact of socio-economic factors on ANC and the determinants, which limits women of childbearing ages and pregnant women from fully receiving quality ANC.

The data that will be generated from this study will go a long way to improve on the quality of ANC delivery on the part of the government and appropriate utilization by women in order to reduce maternal mortality and morbidity.

1.4  Research Questions

1. What is the level of pregnant women’s knowledge on the importance of ANC in the Buea health District.
2. What is the attitude of pregnant women towards ANC in the Buea health district .
3. What are the barriers associated with the utilization of ANC at the Buea health district.

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