Women’s Perceptions about Ante-natal Care Access, Marrere Hospital, Nampula, Mozambique, 2014.

Abstract

Introduction: Mother and newborn mortality rates in Mozambique are the highest in the Eastern African region. Less than four ante-natal visits and low rates of institutional delivery by trained birth attendants are associated with maternal and newborn deaths in the literature. This study aims to understand the perceptions of women in Marrere, Nampula, regarding ante-natal care and determine the barriers to accessing primary health care services.

Methods: Descriptive qualitative study, with researcher led semi structured interviews of pregnant women and women who have given birth within the last year who presented to the Marrere Hospital Mother and Child Health clinic.

Results: We interviewed a total of 30 women, 25 were in their 3^rd trimester of pregnancy and five had given birth within the last year. The 30 women had an average age of 24 years and a mean number of 3,7 pregnancies per women. The group had a low knowledge level regarding need and reasons for ante natal care (13 women, 43%); the majority of the participants presented for their first ante-natal visit in the second trimester of pregnancy (18 women, 60%). The majority of women were illiterates (16 women, 53%). Women (9, 27%) stated that “bad luck” was the cause of their miscarriages and (25 women, 83%) said witchcraft is a strong risk for pregnancies and miscarriages, thus women try to hide their pregnancy and wait until late in the pregnancy to seek ante-natal care.

Discussion: The barriers to ante-natal care access for women in Marrere most commonly mentioned in our study were: 1) lack of knowledge regarding reproductive health and ante-natal care; 2) fear of witchcraft so women don’t tell anyone they are pregnant and only come to anteSnatal visits later in pregnancy or not at all; 3) social and economic difficulties, such as lack of decision power in the family and no or low income, as reported by other studies in Mozambique. The majority of this group points to the fear of witchcraft as a main reason for late ante natal-care.

Conclusion: solutions for knowledge deficit and witchcraft beliefs may be to involve traditional healers, traditional birth attendants, priests, community members and pregnant women in ongoing mother and child health care promotion and education. Using a train the trainer method to enhance health care promotion could be effective.