Barriers to Utilization of Antenatal Care Services in Eastern Nepal

Mass media campaigns have long been a tool for promoting public health. How effective are such campaigns in changing health-related attitudes and behaviors, however, and how has the literature in this area progressed over the past decade? The purpose of the current article is threefold. First, I discuss the importance of health mass media campaigns and raise the question of whether they are capable of effectively impacting public health. Second, I review the literature and discuss what we have learned about the effectiveness of campaigns over the past 10 years. Finally, I conclude with a discussion of possible avenues for the health campaign literature over the next 10 years. The overriding conclusion is the following: The literature is beginning to amass evidence that targeted, well-executed health mass media campaigns can have small-to-moderate effects not only on health knowledge, beliefs, and attitudes, but on behaviors as well, which can translate into major public health impact given the wide reach of mass media. Such impact can only be achieved, however, if principles of effective campaign design are carefully followed.

This paper examines the patterns and determinants of maternal health care utilization across different social settings in South India: in the states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Data from the National Family Health Survey (NFHS) carried out during 1992-93 across most states in India are used. Results show that utilization of maternal health care services is highest in Kerala followed by Tamil Nadu, Andhra Pradesh and Karnataka. Utilization of maternal health care services is not only associated with a range of reproductive, socio-economic, cultural and program factors but also with state and type of health service. The interstate differences in utilization could be partly due to variations in the implementation of maternal health care program as well as differences in availability and accessibility between the states. In the case of antenatal care, there was no significant rural-urban gap, thanks to the role played by the multipurpose health workers posted in the rural areas to provide maternal health care services. The findings of this study provide insights for planning and implementing appropriate maternal health service delivery programs in order to improve the health and well-being of both mother and child.

Background Good quality antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. Quality of ANC is measured by three dimensions: number of visits, timing of initiation of care and inclusion of all recommended components of care. Although some studies report on predictors of the first two indicators, no studies on the third indicator, which measures quality of ANC received, have been conducted in Nepal. Nepal follows the World Health Organization’s recommendations of initiation of ANC within the first four months of pregnancy and at least four ANC visits during the course of an uncomplicated pregnancy. This study aimed to identify factors associated with 1) attendance at four or more ANC visits and 2) receipt of good quality ANC. Methods Data from Nepal Demographic and Health Survey 2011 were analysed for 4,079 mothers. Good quality ANC was defined as that which included all seven recommended components: blood pressure measurement; urine tests for detecting bacteriuria and proteinuria; blood tests for syphilis and anaemia; and provision of iron supplementation, intestinal parasite drugs, tetanus toxoid injections and health education. Results Half the women had four or more ANC visits and 85% had at least one visit. Health education, iron supplementation, blood pressure measurement and tetanus toxoid were the more commonly received components of ANC. Older age, higher parity, and higher levels of education and household economic status of the women were predictors of both attendance at four or more visits and receipt of good quality ANC. Women who did not smoke, had a say in decision-making, whose husbands had higher levels of education and were involved in occupations other than agriculture were more likely to attend four or more visits. Other predictors of women’s receipt of good quality ANC were receiving their ANC from a skilled provider, in a hospital, living in an urban area and being exposed to general media. Conclusions Continued efforts at improving access to quality ANC in Nepal are required. In the short term, less educated women from socioeconomically disadvantaged households require targeting. Long-term improvements require a focus on improving female education.