Identification of Cultural Factors Affecting the Timely First Antenatal Care Visit in Lusaka Province, Zambia
Abstract:
Only 33 per cent
of Zambian women attended their first antenatal care (ANC) visit in the first
trimester in 2021, and
only 64 per cent
completed four or more ANC contacts. To address this challenge, the Ministry of
Health prioritised increasing early ANC attendance from 33 per cent in 2021 to 60 per cent by 2026 as part of a national
strategy to reduce maternal mortality to below 100 per 100,000 by 2026. This
study examined the influence of cultural factors on the timely initiation of
the first ANC visit among pregnant women in Lusaka Province. A cross-sectional survey was
conducted among 371 pregnant women aged 15 to 49 years using a structured
questionnaire to collect quantitative data. Descriptive statistics summarised
demographic characteristics, while bivariate and multivariate analyses assessed
associations between predictor variables and timing of the first ANC visit.
Logistic regression identified independent predictors of delayed initiation,
and Fisher’s exact test was applied at 80% power, a 95% confidence level, and a
significance level of α = 0.05. A total of 432 women were included in the
analysis. Multivariate analysis identified significant cultural determinants of
delayed first ANC visits, including fear of witchcraft, dominance of religious
leaders in decision-making, limited maternal autonomy and constrained
decision-making power, as well as norms surrounding the secrecy of pregnancy. Failure
to address these cultural determinants will perpetuate low rates of early ANC
initiation and contribute to sustained maternal mortality in Lusaka Province.
Future research should incorporate longitudinal designs to strengthen causal
inference.
References:
[1].
World Health Organisation, 2016, WHO
recommendations on antenatal care for a positive pregnancy experience. Geneva:
World Health Organisation.
[2].
Jiwani, S. S.,
Amouzou, A., Carvajal Larenas, F. E., et al.,
2020, Timing and number of antenatal care contacts in low- and middle-income
countries: analysis of DHS and MICS surveys. BMC Pregnancy and Childbirth,
20(1), 1–11. https://doi.org/10.1186/s12884-020-2795-4
[3].
Alem, A. Z.,
Yeshaw, Y., Liyew, A. M., et al., 2022, Timely initiation of antenatal care and
its associated factors among pregnant women in sub-Saharan Africa: a
multi-country analysis of Demographic and Health Surveys. PLoS One,
17(1), e0262411. https://doi.org/10.1371/journal.pone.0262411
[4].
Dowswell, T., Carroli, G., Duley,
L., et al., 2015, Alternative versus standard packages of antenatal care for
low-risk pregnancy. Cochrane Database of Systematic Reviews, (7),
CD000934. https://doi.org/10.1002/14651858.CD000934.pub3
[5].
Abdo, R. A.,
Endalemaw, T. B., Tesso, F. Y., Tura, A. K.,
2023, First-trimester antenatal care contact in Africa: a systematic review and
meta-analysis. BMC Pregnancy and Childbirth, 23(60), 1–16. https://doi.org/10.1186/s12884-023-05442-z
[6].
Moller, A. B., Petzold, M., Chou,
D., Say, L., 2017, Early
antenatal care visit: A systematic analysis of regional and global levels and
trends of coverage from 1990 to 2013. Lancet Global Health, 5(10),
e977–e983.Available at: https://pubmed.ncbi.nlm.nih.gov/28911763/
[7].
Benova, L., Tunçalp, Ö., Moran, A. C.,
Campbell, O. M. R., 2018, Not just a number: examining coverage and content
of antenatal care in low- and middle-income countries. BMJ Global Health,
3(2), e000779. https://doi.org/10.1136/bmjgh-2018-000779
[8].
Gonçalves, A. S.,
Severo, M., Rocha, A., et al., 2022, Antenatal care provision in high-income
countries with universal health systems: a scoping review. Women and Birth,
35(5), e476–e485. https://doi.org/10.1016/j.wombi.2021.09.008
[9].
Puthussery, S., Twamley, K.,
Macfarlane, A., et al., 2022, Disparities in antenatal care initiation and
neonatal outcomes in high-income settings: a population-based study. BMC
Pregnancy and Childbirth, 22(1), 1–13. https://doi.org/10.1186/s12884-022-04520-3
[10].
Okedo-Alex, I. N.,
Akamike, I. C., Ezeanosike, O. B., Uneke,
C. J., 2019, Determinants of antenatal care utilisation in
sub-Saharan Africa: a systematic review. BMJ Open, 9(10), e031890. https://doi.org/10.1136/bmjopen-2019-031890
[11].
Phiri, M., Mwanza, J., Mwiche, A.,
Lemba, M., Malungo, J. R. S., 2025, Delay in timing of first antenatal care
utilisation among women of reproductive age in sub-Saharan Africa: a multilevel
mixed-effects analysis. Journal of Health, Population and Nutrition,
44(139), 1–14.
[12].
Agbaza Mogbojuri, B., Onwubuyah, A. O.,
2023, Socioeconomic and cultural influences on antenatal care utilisation: a
multilevel analysis of five African countries. World Journal of Biological,
Pharmaceutical and Health Sciences, 14(2), 329–337.
[13].
Zambia Statistics Agency (ZamStats),
Ministry of Health (MOH), ICF., 2020, Zambia Demographic and Health Survey
2018. Lusaka (ZM) and Rockville (MD): ZamStats and ICF.
[14]. Sserwanja, Q., Mukunya, D., Habumugisha, T., et al., 2021,
Continuum of maternity care in Zambia: magnitude and determinants. BMC
Pregnancy and Childbirth, 21(604), 1–10. https://doi.org/10.1186/s12884-021-04097-5
[15]. Laisser, R. M., Kafulafula, G., Chirwa, M., et
al., 2022, The tipping point of antenatal engagement: a qualitative study
exploring delayed ANC initiation in Zambia. Women and Birth, 35(6),
e585–e593. https://doi.org/10.1016/j.wombi.2021.11.003
[16].
Ministry of Health, Zambia, 2018,
Antenatal care guidelines for a positive pregnancy experience. Lusaka (ZM):
Government of the Republic of Zambia.
[17].
Banda, I., Michelo, C., Hazemba, A.,
2012, Factors associated with late antenatal care attendance in selected urban
and rural districts of Zambia. Medical Journal of Zambia, 39(3), 29–36.
[18].
Mukumbuta, D., 2015, Determinants of
late initiation of antenatal care among expectant mothers in Kanyama Township,
Lusaka [master’s dissertation]. Lusaka (ZM): University of Zambia.
[19].
Mambwe, P., 2018, Self-delay for
timely antenatal care: rituals and heavy-handed in-laws as cultural practices
hindering early ANC in Lundazi District, Zambia. Texila International
Journal of Public Health, 8(4), 1–9.
[20].
M’soka, N. C.,
Mabuza, L. H., Pretorius, D., 2015, Cultural and health beliefs of
pregnant women in Zambia regarding pregnancy and childbirth. Curationis,
38(1), 1–7.
[21]. Tolefac, P. N., Tamambang, R. F.,
Nguefack, C. T., et al., 2021, Determinants of first antenatal care visit
timing among pregnant women in Africa: a systematic review and meta-analysis. Reproductive
Health, 18(1), 1–14. https://doi.org/10.1186/s12978-021-01105-y
[22]. Alem, A. Z., Yeshaw, Y., Liyew, A. M., Tesema, G. A.,
Alamneh, T. S., Worku, M. G., et al. 2022,
Timely initiation of antenatal care and its associated factors among pregnant
women in sub-Saharan Africa. PLoS One, 17(1), e0262411. Available
at: https://doi.org/10.1371/journal.pone.0262411
[23]. Tesfu, A. A., Aweke, A. M., Gela, G. B., Wudineh, K. G.,
Beyene, F. Y., 2022, Factors
associated with timely initiation of antenatal care among pregnant women in
Bahir Dar City, Ethiopia. Nursing Open, 9(2), 1210–1217. Available
at: https://doi.org/10.1002/nop2.1162
[24]. Towongo, M. F., Ngome, E., Navaneetham, K., Letamo, G., 2020, Factors
associated with women’s timing of first antenatal care visit during their last
pregnancy: Evidence from the 2016 Uganda DHS. BMC Pregnancy and Childbirth,
22, 829. Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03361-3
[25]. Alemu, Y., Aragaw, A.,
2018, Early initiation of first antenatal care visit in Bahir Dar
Zuria Woreda, Ethiopia. Reproductive Health, 15, 203. Available
at: https://doi.org/10.1186/s12978-018-0646-9
[26].
Wolde, H. F., Tsegaye, A. T., Sisay,
M. M., 2019, Late
initiation of antenatal care in South Gondar, Ethiopia. Reproductive Health,
16, 73. Available at: https://doi.org/10.1186/s12978-019-0745-2
[27]. Amoakoh-Coleman, M., Agyepong, I.,
Zuithoff, N., et al., 2016, Completeness and accuracy of data transfer of
routine maternal health services data in Ghana: A facility-level comparison of
paper-based and electronic systems. BMC Health Services Research, 16(1),
https://doi.org/10.1186/s12913-016-1610-9
[28]. Moyer, C. A., Adongo, P. B.,
Aborigo, R. A., et al., 2014, “They treat you like you are not a human being”:
Maltreatment during childbirth in rural northern Ghana. Midwifery,
30(2), 262–268. https://doi.org/10.1016/j.midw.2013.05.006
[29]. Agha, S., and Tappis, H., 2016, The timing
of antenatal care initiation and its determinants in Pakistan. BMC Pregnancy
and Childbirth, 16(1), 190. https://doi.org/10.1186/s12884-016-0970-0
[30]. Titaley, C. R., Dibley, M. J.,
Roberts, C. L., 2010, Factors associated with underutilization of antenatal
care services in Indonesia: A population-based study. BMC Public Health,
10(1), 485. https://doi.org/10.1186/1471-2458-10-485
[31]. Amoakoh-Coleman, M., Agyepong, I.,
Zuithoff, N., et al., 2016, Factors influencing the uptake of intermittent
preventive treatment for malaria in pregnancy (IPTp) in Ghana. Malaria
Journal, 15(1), 316. https://doi.org/10.1186/s12936-016-1390-3
[32]. Akombi, B. J., Agho, K. E., Merom,
D., et al., 2019, Multilevel analysis of factors associated with early
antenatal care visits among pregnant women in Nigeria. BMC Pregnancy and
Childbirth, 19(1), 159. https://doi.org/10.1186/s12884-019-2300-2
[33]. Sharma, J., Aryal, S., Gulshan,
N., et al., 2018, Determinants of first antenatal care visit in Nepal: An
analysis of the Nepal Demographic and Health Survey. BMC Pregnancy and
Childbirth, 18(1), 1–8. https://doi.org/10.1186/s12884-018-2129-7
[34]. Oyekale, A. S., 2017, Assessment
of women’s access to antenatal care services in Nigeria. International
Journal of Women’s Health, 9, 581–598. https://doi.org/10.2147/IJWH.S131078
[35]. Kumar, P., and Dhillon, P., 2016, Household-
and community-level determinants of low birth weight in India. Journal of
Biosocial Science, 48(5), 1–19. https://doi.org/10.1017/S0021932016000242
[36]. Gebrehiwot, T., Goicolea, I.,
Edin, K., et al., 2019, Making pragmatic choices: Women’s experiences of
delivery care in rural northern Ethiopia. BMJ Open, 9(3), e024945. https://doi.org/10.1136/bmjopen-2018-024945
[37]. Rahman, A., Rahman, M. M., Rahman,
M. A., et al., 2018, Determinants of early antenatal care initiation in
Bangladesh. Public Health, 157, 91–99. https://doi.org/10.1016/j.puhe.2018.01.002
[38]. Agha, S., and Tappis, H., 2016, Maternal
and child health service delivery in conflict settings: Findings from Pakistan.
Reproductive Health, 13(1), 51. https://doi.org/10.1186/s12978-016-0175-1
[39]. Chukwuma, A., Wosu, A., Mbachu,
C., et al., 2020, Quality of antenatal care predicts early postpartum modern
contraceptive uptake in Kenya. PLOS One, 15(10), e0239311. https://doi.org/10.1371/journal.pone.0239311
[40]. Matanda, D. J., Urke, H. B.,
Mittelmark, M. B., 2019, Determinants of maternal health service utilization in
Zimbabwe. BMC Pregnancy and Childbirth, 19(1), 1–9. https://doi.org/10.1186/s12884-019-2390-x
[41]. Khanal, V., Adhikari, M., Karkee, R., et al., 2017, Factors associated with the first antenatal care visit in Nepal. Women and Birth, 31(2), e100–e106. https://doi.org/10.1016/j.wombi.2017.08.003
