FACTORS INFLUENCING DECISION TO USE ANTENATAL CARE SERVICES AMONG WOMEN IN

Background: Antenatal care is the care that a woman receives during pregnancy that helps to ensure healthy outcomes for the women and newborns. It is one of the pillars of safe motherhood initiative. Nigeria’s maternal mortality ratio is estimated to be 814/100,000 live births with regional variations. Proper antenatal care is a viable option at reducing maternal mortality rate in Nigeria. Materials and methods: This was a longitudinal study carried out at the antenatal clinic of the University of Uyo Teaching Hospital, Uyo, Akwa Ibom State. A purposive sampling method was adopted to recruit 330 eligible antenatal clinic attendees. A Semi-Structured Interviewer-administered questionnaire was used to obtain information on the background characteristics of respondents including socio-demographic characteristics and reasons for utilizing antenatal care. The data entry and analysis were done using SPSS version 17.0 with the level of significance set at p<0.05, Results: A total of 330 pregnant women were recruited for the study. The mean age of the respondents was 29.37± 4.255 with a range of 16-42 years. Nearly all the women were Christians (99.4%) and married (95.2%). About 80.6% lived in urban settlements and more than half of them (58.5%) and their husbands (68.5%) had tertiary level of education. Almost two-third of the respondents (64.5%) were of parity one to four. The most common reason for attending antenatal clinic was to assess foetal wellbeing (90.6%). In about one-third of respondents their husbands alone decided place to receive

antenatal care while 27.3% decided jointly as a couple.Regression analysis of the data obtained showed two factors as being significant in decision to use antenatal care services.These were nature and extent of antenatal care services, and knowledge of benefits of use of antenatal care services.Conclusion: Decision to use antenatal care (ANC) services is mainly influenced by the desires of the pregnant women to have their babies assessed for wellbeing as well as to detect any pregnancy-related disorders.This shows that women have good knowledge of the benefits of routine antenatal care services.
Key words: Factors influencing; antenatal care services; women; University Teaching Hospital; Uyo Antenatal care is the care that a woman receives during pregnancy that helps to ensure healthy outcomes for the women and 1 newborns.It is one of the pillars of safe 2 motherhood initiative.Focused antenatal care was introduced by World Health Organization in 2001 where adequacy of utilization is assumed when the expectant mother can attend the minimum four visits as 1,3 recommended.The fewer antenatal visits is not likely to increase maternal or fetal risks 4 when compared to the traditional model.The first visit is scheduled ideally before twelve weeks but not later than sixteen weeks, the second visit at twenty-four to twenty-eight weeks, the third at thirty-two weeks and the 1-4 fourth visit at thirty-six weeks.Focused antenatal care employs four main intervention strategies.These include health promotion and disease prevention, early detection and treatment of complication and existing diseases, birth preparedness/complication maternal/newborn mortality.There is paucity of studies that identify these factors in the Akwa Ibom State.This study was aimed at identifying factors that influence decision to use antenatal care services among pregnant women.

MATERIAL AND METHODS
This longitudinal study was carried out at the antenatal clinic of the University of Uyo Teaching Hospital, located in Uyo, the Capital of Akwa Ibom State in the South-South Geopolitical zone of Nigeria.Using the Cochran formula for large populations, a sample size of 330 was calculated from an estimated study population of 3,874 clinic attendees taking into consideration the state antenatal care utilization rate of 67% at 95% confidence interval, taking degree of precision to be 5% and non-response rate 5%.A purposive sampling method was adopted where all consenting eligible respondents were consecutively recruited from July 2013 to September 2013.A Semi-Structured Interviewer-administered questionnaire sought information on the background characteristics of respondents including reasons for utilizing antenatal care.A written consent was obtained from all respondents and women that were very ill were excluded from the study.A total of 330 pregnant women were recruited for the study.The socio-demographic distribution of the respondents is shown in table 1.The mean age of the respondents was 29.37± 4.255 with a range of 16-42 years.Nearly all the women were Christians (99.4%) and married (95.2%).About 80.6% lived in urban settlements and more than half of them (58.5%) and their husbands (68.5%) had tertiary of education.Almost twothird of the respondents (64.5%) were of parity one to four.Table 2 showed the respondents' antenatal profile.Data from 275 respondents showed that 93.4% of them had more than 4 antenatal visits although only 15.4% of them booked in their first trimester.The most common reason for attending antenatal clinic was to assess foetal wellbeing (90.6%).Nearly one-third of respondents suggested that their husbands alone decided place to receive antenatal care while 27.3% decided jointly as a couple.

DISCUSSION
Maternal age, education and marital status were not identified as factors that influence decision to use antenatal care services in this study.This contrasts with similar studies which identified them as significant risk 14,23,24 factors.
After multiple regression, two factors were found to be significant at influencing the decision to use antenatal care.The first was the Nature and extent of antenatal care services provided by the health facility (p=0.000,SE=0.145).This was like other studies which reported that good antenatal care services provided tend to improve health-seeking behaviours during pregnancy.10,14In this study, the most reported services were measurement of weight (99.1%) and blood pressure (99.1%).11,14,23 This was like findings in other studies.The second factor was the knowledge of benefits derived from antenatal care (p=0.000,SE=0.148).Other studies with similar results found out that adequate knowledge gained during antenatal care visits influenced better health outcomes among 25 pregnant women.It is worthy to note that although the prevalence of women attending 4 or more antenatal clinic visits in this study was 93.4%,only 15.4% registered in their first trimester.More than half of them (57%) registered in their second trimester.This finding was like high rates of registration at antenatal clinics in the second trimester reported in other 26,27 studies.Various reasons for late booking given in other studies included perceived correct time, inappropriate advice by providers, time constraint and incidence of 28 unplanned pregnancies.In this study, about one-third of respondents (31.5%) reported their partners as the sole decision-maker of place of antenatal care, about a quarter (27.3%) made joint decision with their husbands and 23 percent decided on their own.Another study with slightly similar findings was in Uganda were it was reported that 40.5 percent of the pregnant women jointly decided with their partner to use antenatal care services, 35 percent deciding on their own and 14.3 percent had their 20 partners decide alone for them.

CONCLUSION
To fully utilize antenatal care services and gain adequate knowledge, pregnant women registration in first trimester increases ANC utilization and knowledge gained.Medical practitioners who serve as the gate keepers should provide pre-conception care for couples.The robust involvement of health care practitioners educating women during ANC will increase their knowledge of the benefits of ANC services.
Limitation of study: Due to the nature of the questionnaire, there was the possibility of the women considering the interviewer as part of the health team creating bias in response.This was reduced with the use of informed consent that specified full antenatal care service would be rendered even if respondents decide to opt-out of the study.