Socio-cultural determinants of first trimester antenatal care (ANC) visits in Kalabo district Zambia

Abstract

Globally, more than 50% of pregnant women attend antenatal care in the first trimester in most developed countries. However, in developing countries, less than 50% of pregnant women do so. Timing of the first antenatal care visit in the first trimester is important because it allows for sufficient time to identify and treat problems such as anemia, malaria, HIV and STIs. The objective of the study was to establish the sociocultural determinants of first trimester antenatal care visits in Kalabo district of Western Province in Zambia. We used a mixed-methods approach. The convergent parallel design was employed. A cross sectional study was used in the quantitative approach while the qualitative one used a case study. A sample of 454 pregnant women aged between 14 and 49 years were selected for interviews through multi-stage cluster sampling and three focus group discussions were held. The quantitative data was analyzed through multiple logistic regression using STATA version 14 while thematic analysis was used in the qualitative approach. The first trimester antenatal care attendances are still very low at 34.6%. Socio-cultural determinants related to awareness of the right time to attend ANC (first trimester) and marital status were found to be highly associated with First trimester Antenatal care. Awareness was found two times more likely being associated with antenatal attendance in first trimester among women (AOR =2.03, CI=1.50—4.48, P-Value=0.004) and married women were 2 times more likely to attend ANC in the first trimester (AOR=2.59, CI=1.17-3.54, P Value=0.019). Women also described their not being sure about the existence of the pregnancy in the earliest stages as a factor hindering them to attend ANC early. Cultural beliefs and practices, lack of male involvement, fear of HIV testing, age, marital status, and age of partner, distance and health status, decision making challenges, economic problems were also described as barriers to first trimester ANC initiation. The proportion of first trimester antenatal care attendances is still very low being affected by mostly the socio-cultural factors. The study has implications for strengthening health education on the timing of antenatal care and provision of community –based pregnancy test kits in rural communities.