Abstract
Background:
Antenatal care (ANC) is essential to providing holistic care for health promotion, preventive health services, and the overall wellbeing of pregnant women.
Material and Methods:
To assess the ANC utilization and identify influencing factors among mothers in Meghalaya. A cross-sectional quantitative study was conducted in an aspirational district of Meghalaya. 360 mothers over 18 years old who gave birth in the past 12 months, selected through a multistage sampling technique. This study was conducted from August 2023 to July 2024.
Statistical Analysis Used:
Data were analyzed using SPSS version 27.0. Bivariate logistic regression was applied at P < 0.05.
Results:
In this study, 87.2% of mothers attended ANC clinics during their last pregnancy, with 29.4% having four or more checkups and 65.3% registering in the first trimester. Significant factors influencing ANC attendance included women’s occupation, family income, travel costs, distance to the nearest health facility, and satisfaction with ANC services. Women with a monthly income of Rs. 5001–10,000 were more likely to attend ANC visits (adjusted odds ratio [AOR] =34.86). Satisfaction with ANC services also positively influenced attendance, with satisfied women more likely to attend ANC visits (AOR = 7.73). Employed women, particularly farmers, were more likely to attend ANC visits (AOR = 2. 53); high travel expenses (AOR = 0.11) and proximity of nearest health facilities (AOR=0.56) were associated with lower ANC visits attendance.
Conclusions:
The study highlights that, despite many women registering for ANC, attendance rates remain insufficient. These insights underscore the need to address economic and structural barriers to improve ANC attendance among pregnant women.
Keywords: Antenatal care, antenatal services, India, pregnancy, utilization
INTRODUCTION
Antenatal care (ANC) plays a crucial role in ensuring the health and wellbeing of both mothers and their babies.[1] ANC is an essential opportunity to educate women about the symptoms and danger signs of high-risk pregnancies, enabling them to seek emergency medical treatment when needed. It plays a critical role in identifying issues early, preventing unfavorable pregnancy outcomes, and improving the health of both mothers and their infants. By detecting and addressing potential complications during pregnancy, ANC significantly reduces the risk of adverse birth outcomes.[2] Two essential elements of healthcare that have a good effect on the health of the pregnant woman are ANC and healthcare-seeking behavior. Pregnancy-related complications can be avoided with high-quality antenatal care.[1] According to WHO recommendations, a pregnant woman must have at least four antenatal visits and should include administration of Tetanus diphtheria Toxoid (Td) immunization, Iron Folic Acid Tablets, screening and treatment for infections, and recognition of danger symptoms during pregnancy.[3] Worldwide, 85% of pregnant mothers had access to quality ANC with a skilled health professional, out of which only about 51% of these women achieved the minimal requirement of four antenatal visits during pregnancy.[4] In India, ANC services are free of cost at public health facilities under various government initiatives, such as the Janani Suraksha Yojana (JSY) and Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA). Despite these efforts, disparities in the utilization of ANC services persist across the country.
The utilization of services for ANC is a complicated phenomenon with numerous determinants. It is influenced by geographic distribution,[5] accessibility (distance and transportation),[6] availability, affordability and quality of care (availability of trained human resources and equipment in health facilities), and sociodemographic and cultural factors.[7]
Meghalaya is located between Assam state and Bangladesh. The capital is Shillong, and the state covers an area of approximately 22,430 km2. In 2016, the population was estimated by extrapolation to be around 3.4 million people. In 2011, the year of the most recent census in India, the population density was calculated as an average of 132 people/km2, composed of 50.3% male and 49.7% female, with 19.2% between 0 and 6 years of age and the overall literacy at 74%. The mean household size was 5.5 people. Ri Bhoi, located in Meghalaya, is one of India’s Aspirational Districts, identified by The National Institution for Transforming India Aayog under the Aspirational Districts Programme. The program focuses on transforming districts with the aim of improving the quality of life and economic productivity of citizens.
According to the National Family Health Survey-5 (NFHS-5), 53.9% of mothers in Meghalaya had antenatal checkups in the first trimester, and 52.0% had at least four antenatal checkups, compared to the national averages of 70.0% and 58.1%, respectively.[8,9] In Ri Bhoi district, 56.1% of mothers received antenatal checkups in the first trimester, and 61.0% completed at least four antenatal visits.[8]
Considering the usage of services for ANC services in Ri Bhoi District, our study is designed to determine facilitators and barriers to the utilization of ANC services by women in this district. Additionally, to increase the uptake of services for maternal health care, there is a need for better knowledge of the reasons affecting usage of health care services during pregnancy.
Objectives
In rural areas of Meghalaya:
To assess the utilization of ANC among mothers
To identify the facilitators and barriers to accessing the ANC services as perceived by mothers.
MATERIALS AND METHODS
Study setting
A cross-sectional study was conducted in Ri Bhoi District of Meghalaya, which is also the only Aspirational District in the State of Meghalaya.
Sample size and sampling
According to NFHS-5, the prevalence of mothers having at least four ANC visits was 52.2%. The current sample size was designed to be sufficient to assess the uptake of services for maternal health among eligible participants with 95% confidence, a precision level of 7%, and a design effect of 1.5 at our study sites. The estimated sample size was 324; after taking a nonresponse rate of 10%, the sample size was 360. The researcher interviewed a total of 360 mothers from the entire district. Data were collected from August 2023 to July 2024. Eligible women were selected through records of the public health system (ASHA/Anganwadi workers), and informed written consent was taken. Women participating in the study were above the age of 18 years and had given birth to a child in the past 12 months residing in the study area at the time of data collection. Women who have moved out of the village and those who are not available for interviews after three visits were excluded from the study.
Multistage sampling method was adopted to select the sites of data collection for the study. At the first stage, Ri Bhoi District was selected using a purposive sampling technique as it is the only aspirational district in the State and also the Non-Priority District. In the second stage, all the three blocks from the district were selected for the study adopting the complete enumeration method. Following this, two PHCs/CHCs were selected from all the blocks using a simple random method (lottery method) in the third stage. Subsequently, three villages from each block were selected based on the distance. The village closest to the selected PHCs/CHCs, the village which is equidistant from PHCs/CHCs, and the village farthest from PHCs/CHCs were included. Finally, 20 participants were recruited from each village, totaling to 60 individuals from each CHC/PHC. Eligible women were selected using a simple random method (lottery method) from the sampling frame provided by the public health system (ASHA/Anganwadi workers). Following informed consent, we enrolled the eligible women as per the inclusion criteria stated above.
Data collection and study tools
A survey was conducted at a village level. Data collection was done by face-to-face interviews in a pen and paper format using a predesigned validated questionnaire in the local language to ensure clarity and comprehension. Demographic information, health-seeking behavior, ANC services accessed, and utilization of ANC services were obtained from the participants. The Standard of Living Index was used to measure the living standards of participants and was calculated using the NFHS criteria.[10]
Mothers’ satisfaction on ANC services was measured using a three-point scale (agree, neutral, and disagree) assessment tool. Point 1 was given for disagree, 2 for neutral, and 3 for agree. The answer of each question was summed up and divided by the total number of questions and then multiplied by 100 to determine the level of satisfaction. Accordingly, mothers’ satisfaction was taken as ‘satisfied’ if participants scored 75% and above points and ‘dissatisfied’ if they scored less than 75%.
Data management and analysis
The data were imported into Excel ver. 10 (Microsoft Inc.), cleaned, and recoded. The data collected were analyzed using Statistical Package of Social Sciences (SPSS) ver. 27. 0 (SPSS Inc, Chicago, IL, USA). The categorical variables were expressed in frequency and percentage, and the continuous variable in mean and standard deviation. Univariate analysis was done, and variables having significant association were taken into the final regression model for multivariate logistic regression analysis by applying enter method. Crude odds ratio and adjusted odds ratio (AOR) were reported. P <0.05 was considered to be statistically significant.
Ethical considerations
Study approval was obtained from the Sikkim Manipal Institute of Medical Sciences Institution Ethics Committee (SMIMS/IEC/2023-66). Permission was also obtained from the offices of the Directorate of Health Services (MCH and FW) and the District Medical and Health Officer, Ri Bhoi District. Thereafter, eligible individuals were approached separately, and written informed consent was taken from all the participants.
RESULTS
The study interviewed a total of 360 mothers. The majority of women (70.6%) were aged 30 years or younger, and 57.8% of husbands were also in this age group. The mean age of the respondents was 28.4 years. Among women below 30 years, 70.8% had less than four ANC visits, while 29.2% had more than four visits. Most participants (95.6%) had education up to 10th grade, and nearly half (47.2%) of the respondents were farmers. Almost 68.3% of the respondents belong to the nuclear family, and the majority (66.4%) had a family size of less than six members. About 70.6% of the respondents had a monthly family income of Rs 5001–10,000. The majority (68.3%) of the participants had a medium standard of living [Table 1].
Table 1.
Sociodemographic and accessibility characteristics of respondents (n=360)
| Variables | Total Frequency (%) | Women with <4 ANC visits | Women with >4 ANC visits | P |
|---|---|---|---|---|
| Age of the participants (in years) | ||||
| ≤30 | 254 (70.6) | 179 (70.5) | 75 (70.8) | 0.96 |
| ≥31 | 106 (29.4) | 75 (29.5) | 31 (29.2) | |
| Age of the husbands (in years) | ||||
| ≤30 | 208 (57.8) | 144 (56.7) | 64 (60.4) | 0.52 |
| ≥31 | 152 (42.2) | 110 (43.3) | 42 (39.6) | |
| Educational level of participants | ||||
| Up to 10th standard | 344 (95.6) | 242 (95.3) | 102 (96.2) | 0.69 |
| 11th standard and above | 16 (4.4) | 12 (4.7) | 4 (3.8) | |
| Educational level of husband | ||||
| Up to 10th standard | 54 (15.0) | 219 (86.5) | 87 (82.1) | 0.32 |
| 11th standard and above | 306 (85.0) | 35 (13.8) | 19 (17.9) | |
| Occupation status | ||||
| House wife | 145 (40.3) | 108 (74.5) | 37 (25.5) | 0.34 |
| Farmer | 170 (47.2) | 117 (68.8) | 53 (31.2) | |
| Others | 45 (12.5) | 29 (11.4) | 16 (15.1) | |
| Marital status | ||||
| Married staying with husband | 356 (98.9) | 252 (70.8) | 104 (29.2) | 0.36 |
| Married but not staying with husband | 4 (1.1) | 2 (50.0) | 2 (50.0) | |
| Type of family | ||||
| Nuclear | 246 (68.3) | 174 (68.5) | 72 (67.9) | 0.35 |
| Joint/extended | 114 (31.7) | 80 (31.5) | 34 (32.1) | |
| Family size | ||||
| <6 members | 239 (66.4) | 174 (68.5) | 65 (61.3) | 0.19 |
| ≥7 members | 121 (33.6) | 80 (31.5) | 41 (38.7) | |
| Monthly Family income (in Rs) | ||||
| ≤5000 | 62 (17.2) | 61 (98.4) | 1 (1.6) | <0.01* |
| 5001–10,000 | 254 (70.6) | 171 (67.3) | 83 (32.7) | |
| ≥10,001 | 44 (12.2) | 22 (50.0) | 22 (50.0) | |
| Standard of living index | ||||
| Low | 157 (43.6) | 110 (70.1) | 47 (29.9) | 0.85 |
| Medium | 198 (55.5) | 142 (71.7) | 56 (28.3) | |
| High | 5 (1.4) | 2 (40.0) | 3 (60.0) | |
| Nearest Health Facility | ||||
| Community health center/district hospital | 109 (30.3) | 53 (20.9) | 56 (52.8) | <0.01 |
| Subcentre HWC | 87 (24.2) | 86 (33.9) | 1 (0.9) | |
| Primary health center | 116 (32.2) | 68 (26.8) | 48 (45.3) | |
| Private clinic/hospital | 48 (13.3) | 47 (18.5) | 1 (0.9) | |
| Distance to the nearest health facility (in km) | ||||
| 0–4 | 133 (36.9) | 84 (63.2) | 49 (36.8) | 0.02* |
| ≥5 | 227 (63.1) | 170 (74.9) | 57 (25.1) | |
| Traveling cost to reach the nearest health facility (in Rs) | ||||
| No cost | 73 (20.3) | 24 (32.9) | 49 (67.1) | <0.01* |
| ≤50 | 48 (13.3) | 34 (70.8) | 14 (29.2) | |
| ≥51 | 239 (66.4) | 196 (82.0) | 43 (18.0) | |
| Mode of transportation | ||||
| Public transportation | 255 (70.8) | 197 (77.3) | 58 (22.7) | <0.01* |
| Walking | 67 (18.6) | 21 (31.3) | 46 (68.7) | |
| Own vehicle | 38 (10.6 | 36 (94.7) | 2 (5.3) | |
*P < 0.05=Significant. ANC=Antenatal care
Regarding access to the nearest health facilities, approximately 32.2% of the mothers indicated that a Primary Health Centre was their closest option. Among those with more than four ANC visits, 52.8% accessed a community health center or district hospital, while most women with fewer visits (33.9%) went to a subcenter or private clinic. Women with more than four ANC visits were more likely to have accessed health facilities within 0–4 km (36.8%), while those with fewer visits had to travel longer distances (74.9%). Also, women with fewer ANC visits incurred a cost of more than Rs 51 (82.0%), while those with more than four visits often had little to no travel cost (67.7%). Additionally, women with fewer ANC visits primarily used their own vehicles (94.7%) or public transport (77.3%), while those with more than four ANC visits often walked to the facility [Table 1].
The obstetric history of the respondents reveals that 295 (81.9%) of the mothers married between 19 and 30 years. Additionally, 57.7% were multigravida and nearly half (55.3%) were multipara. About 10% had a history of abortions.
During the recent pregnancy, 346 (96.1%) mothers attended the ANC. About 41.7% utilized the Subcenter HWC for checkups. Most (95.8%) of them went for checkups in the first trimester, and only about 29.5% had four or more ANC checkups. The reasons for not attending ANC were: Mothers did not feel the need to attend (2.5%) and families did not allow to contact healthcare workers (1.4%). Most (92.8%) of the mothers reported that they did not pay for the ANC services because they attended the ANC clinics at government healthcare facilities where Maternal and Child Health services are provided free of cost. All mothers received tetanus toxoid, and high percentages received IFA tablets (95.6%) and albendazole tablets (92.2%). Additionally, a large proportion received various health checks: abdominal examination (95.8%), weight check (100%), height check (67.2%), blood pressure check (95.6%), urine test (94.7%), and blood test (94.4%) by healthcare providers [Table 2].
Table 2.
Antenatal care services utilization (n=360)
| Variables | Frequency (%) |
|---|---|
| Attending ANC in the last pregnancy (n=360) | 314 (87.2) |
| Received tetanus toxoid (n=314) | 314 (100.0) |
| Consumed IFA tablets (n=314) | 170 (54.1) |
| Consumed calcium tablets (n=314) | 310 (98.7) |
| Consumed albendazole tablets (n=314) | 303 (96.5) |
| Weight checked (n=314) | 313 (99.7) |
| Height checked (n=314) | 210 (66.9) |
| Blood pressure checked (n=314) | 308 (98.1) |
| Urine test done (n=314) | 310 (98.7) |
| Blood test done (n=314) | 308 (98.1) |
| Health facility utilized (n=314) | |
| Subcentre HWC Primary Health Centre HWC Community Health Centre/District Hospital Private clinics |
142 (45.2) 84 (26.8) 80 (25.5) 8 (2.5) |
| Timing of ANC (n=314) | |
| 1–3 months 4–6 months 7–9 months |
205 (65.3) 103 (32.8) 6 (1.9) |
| Number of ANC visits (n=360) | |
| Zero One Two Three Four or more |
46 (12.8) 178 (49.4) 26 (7.2) 4 (1.1) 106 (29.4) |
| Person providing the ANC services (n=314) | |
| ANM/CHO Doctor Staff nurse |
153 (48.7) 151 (48.1) 10 (3.2) |
| Reasons for not attending ANC (n=46) | |
| Not needed Family does not allow to contact health care workers |
39 (84.7) 7 (15.2) |
ANC=Antenatal care
To assess the respondents’ satisfaction with the quality of ANC services among mothers attending the ANC clinic, participants were asked to rate the services on a three-point Likert scale. The lowest-rated attributes were the “Overall infrastructure of the health care center (including space, design, power, water, hygiene, sanitation, and equipment),” with 17% of respondents rating it as “Disagree,” and the “consultation received from the specialist,” which 14% of respondents rated as “Disagree.” The highest-rated attributes were “comfort during the registration process,” with 96% of respondents rating it as “Agree,” and the “promptness in receiving investigation reports,” which 98% of respondents rated as “Agree” [Figure 1].
Figure 1.
Percentage distribution of the respondents according to their satisfaction with the quality of antenatal care services (n = 346)
The findings from univariable and multivariable analyses, detailed in Table 3, include crude and adjusted odds ratios for ANC utilization based on various explanatory variables, along with reference groups, significance levels, and confidence intervals. The utilization of ANC services is influenced by various socioeconomic factors that can either facilitate or hinder attendance. In this present study, the key facilitators include higher family income, maternal occupation, and satisfaction with ANC services, while barriers encompass distance to reach the nearest health centre and travel costs. Understanding these dynamics is crucial for improving maternal health outcomes. Women from families earning Rs. 5001–10,000 were 21 times more likely to have ≥4 ANC visits compared to those earning ≤5000 (AOR = 20.78, 95% confidence interval [CI]: 2.76–157.13, P < 0.001). Those earning ≥10,001 had the highest likelihood of more than four ANC visits (AOR = 47.04, 95% CI: 5.56–396.64, P < 0.001). Similarly, women satisfied with ANC services were 7.73 times more likely to have ≥4 visits compared to unsatisfied women (AOR = 7.73, 95% CI: 3.16–18.34, P < 0.001). Farmers have a significantly higher likelihood of attending ≥4 ANC visits compared to housewives (AOR = 2.53, 95% CI: 1.33–4.82). Women residing with distance requiring more than 5 km to reach the nearest health center were 44% less likely to have more than four ANC visits (UOR = 0.56, 95% CI: 0.36–0.91, P = 0.02). Additionally, women incurring costs less than Rs. 50 had lower odds of adequate ANC visits (AOR = 0.11, 95% CI: 0.04–0.29, P < 0.001). Higher transportation costs (≥Rs 50) were strongly associated with reduced odds of adequate ANC visits (AOR = 0.73, 95% CI: 0.03–0.17, P < 0.001).
Table 3.
Unadjusted and adjusted odds ratio between antenatal care visits and the selected variables (n=360)
| Variables | Antenatal care visits |
Unadjusted odds ratio (95% CI) | P | Adjusted odds ratio (95% CI) | P | |
|---|---|---|---|---|---|---|
| <4 times n=254 (70.6 %) | ≥4 times n=106 (29.4 %) | |||||
| Occupation status of the respondents | ||||||
| Housewife | 108 (74.5) | 37 (25.5) | 1 | 1 | ||
| Farmer | 117 (68.8) | 53 (31.2) | 1.32 (0.81–2.17) | 0.27 | 2.53 (1.33–4.82) | 0.01* |
| Others | 29 (11.4) | 16 (15.1) | 1.61 (0.79–3.30) | 0.19* | 1.74 (0.72–4.19) | 0.22 |
| Monthly family income (in Rs) | ||||||
| ≤5000 | 61 (98.4) | 1 (1.6) | 1 | 1 | ||
| 5001–10,000 | 171 (67.3) | 83 (32.7) | 29.61 (4.03–217.31) | 0.001* | 20.78 (2.75–157.13) | <0.001* |
| ≥10,001 | 22 (50.0) | 22 (50.0) | 61.00 (7.76–79.77) | <0.001* | 47.04 (5.56–396.64) | <0.001* |
| Distance to the nearest health facility (in km) | ||||||
| 0–4 | 84 (63.2) | 49 (36.8) | 1 | 1 | ||
| ≥5 | 170 (74.9) | 57 (25.1) | 0.56 (0.36–0.91) | 0.02* | 1.36 (0.71–2.62) | 0.35 |
| Cost in reaching the nearest health facility (in Rs) | ||||||
| No cost | 24 (32.9) | 49 (67.1) | 1 | 1 | ||
| <50 | 34 (70.8) | 14 (29.2) | 0.20 (0.09–0.44) | <0.001* | 0.11 (0.04–0.29) | <0.001* |
| ≥50 | 196 (82.0) | 43 (18.0) | 0.11 (0.61–0.19) | <0.001* | 0.73 (0.03–0.17) | <0.001* |
| Satisfaction with ANC services | ||||||
| Unsatisfied | 46 (44.7) | 57 (55.3) | 1 | 1 | ||
| Satisfied | 0 (0.0) | 257 (100.0) | 5.54 (2.76–11.16) | <0.001* | 7.73 (3.16–18.34) | <0.001* |
*P<0.05=Significant. CI=Confidence interval, ANC=Antenatal care
DISCUSSION
This community-based cross-sectional study was conducted among mothers in Ri Bhoi district, identified as an aspirational district in Meghalaya under the Aspirational District Programme of the Government of India, to assess the utilization of ANC services and the factors influencing it. The study identified several significant factors that independently correlated with using ANC services, including the mother’s occupation, monthly family income, travel costs to the nearest health facility, type of health facility, accessed, mode of transportation to reach the facility, and satisfaction with ANC services.
This study found that a high percentage of mothers (87.2%) attended ANC clinics at least once in their recent pregnancy, consistent with the WHO recommendations[11] and also reflecting positive maternal healthcare-seeking behavior.[12] Additionally, 93.9% of these mothers utilized government health facilities, underscoring the critical role of the public healthcare system in delivering maternal health services. Similar findings have been reported in various studies conducted in several states of India, such as Himachal Pradesh,[13] Andhra Pradesh,[14] and Maharashtra,[15] as well as in international research from Ethiopia,[16] Namibia,[17] and Tanzania,[18] where most of the women utilized government health facilities for ANC visits. Our study also revealed that among those who did not avail ANC services, 34 (84.7%) reported that they did not perceive the need for ANC. These findings reiterate and emphasize the importance and needs to ensure affordability, accessibility, and availability of skilled healthcare providers. They also underscore the importance of enhancing awareness and strengthening public trust on health programs for sustaining and improving ANC utilization. Furthermore, this study found that 65.3% of women received ANC during the first trimester of pregnancy in this study. Early ANC initiation is crucial as it allows timely screening for potential complications, nutritional counseling, and essential interventions that can improve pregnancy outcomes. However, the result of this study is lower compared to the findings in other studies.[19,20] However, the percentage of first-trimester registration is higher than the findings of Arunachal Pradesh (36.9%)[21] and Nagaland (24.7%).[22]
Our study also showed that only 29.5% of mothers attended ANC checkups more than four times, indicating a lower adherence to the recommended ANC visit guidelines. These findings are consistent with several other studies[23,24] which have reported that only a small proportion of mothers had a minimum of four ANC visits. The lower rate in our study compared to NFHS data for Meghalaya may be due to our focus on rural and hard-to-reach areas, where access to health services is limited. Other factors like differences in data collection time and local challenges may also have contributed to the lower attendance. However, the percentage of four ANC checkup is lower than the findings from Tamil Nadu (81.1%),[21,25] Sikkim (74.7%),[26] and Mizoram (61.4%).[27]
Our study further highlighted that women with a monthly family income of Rs 5001–10000 were less likely to attend ANC visits compared to higher-income groups. This parallels the findings from other studies[28,29,30] indicating that women within the same income bracket were less likely to utilize ANC services. This strong negative association highlights the financial barriers that lower-income families face in accessing maternal healthcare services. Limited financial resources may hinder transportation to healthcare facilities or lead to additional out-of-pocket expenses that discourage mothers from attending ANC.
Our study also revealed a significant relationship between a mother’s occupation and the frequency of ANC visits, with working mothers demonstrating higher compliance than nonworking mothers. Findings from various studies reported that working mothers were more likely to attend ANC visits as they have due to better access to resources and healthcare information.[31] Occupation is generally linked with higher family income, which eases transportation costs and improves access to better healthcare centers, thereby increasing ANC attendance.[32] On the other hand, mothers who are not working may face financial constraints that limit their ability to seek regular ANC.[32] This finding contrasts with other studies, which suggest that maternal employment status can impact the use of ANC services, often showing lower compliance among working mothers than nonworking ones.[33,34] Additionally, this study also showed an association between the frequency of ANC visits with satisfaction with ANC services, where women who were satisfied with ANC services were more likely to have four or more visits. Satisfaction with ANC services is associated with more frequent visits, which play a vital role in improving both maternal and neonatal health outcomes.[35] These findings underscore the importance of service quality in motivating women to make effective use of ANC services. This result is supported by many studies.[36,37,38]
This study highlights that the proximity to the nearest health facilities and the availability of transport significantly influence ANC visits among women. Women residing farther from health centers are less likely to attend regular ANC checks, showing a negative correlation between distance and ANC utilization. Similar findings have been reported in many studies, which show that increased distance to health facilities is associated with lower ANC visit rates.[39,40] Additionally, transportation availability further influences this relationship, either enabling or restricting access to care. Also, access to transportation is essential as women facing distance-related challenges often experience longer travel times, which can discourage them from seeking care.[41]
This present study shows an association between transportation cost and ANC visits. Women incurring lower transportation costs (<Rs. 50) tend to have lower odds of attending adequate ANC visits, while those facing higher costs (Rs. 50 or more) are strongly associated with inadequate visits. This highlights the economic barriers that can affect maternal healthcare access. These findings are supported by the studies conducted in South East Asia.[42,43]
In addition, the limitations of this study could be that the analysis was based on self-report, which may be affected by recall bias during the survey, and the conclusion from this study may not be relevant for the whole state and the urban areas.
CONCLUSIONS
The present study points out that although a good proportion of pregnant women registered for ANC, the number of ANC attendees was not sufficient. Despite the government’s efforts to introduce various financial schemes and incentives that are aimed at improving and increasing ANC checkups, the utilization remains suboptimal. To address these issues, it is essential to increase community awareness and empowering them with real-time information about the importance of ANC visits and the schemes available through a holistic preventive approach. Widening and strengthening the coverage of existing maternity care schemes, such as the Pradhan Mantri Matru Vandana Yojana and the PMSMA, are vital in enhancing access to healthcare services and increasing awareness about maternal health promoting timely and regular ANC. This includes actively engaging active platforms in the community such as the Village Health and Sanitation Committee and the Community Gender Health Activists to deliver awareness and promote active participation. Additionally, access to ANC services by strengthening transportation options through the State initiative Chief Minister Safe Motherhood Schemes to address the barriers in the far-flung areas is essential. Furthermore, promoting awareness and access to birth spacing methods, including male engagement, needs to be encouraged. A combined effort involving different strategies and active participation from the community will be vital in improving the uptake of the ANC services.
Conflicts of interest
There are no conflicts of interest.
Acknowledgement
I would like to thank Sikkim Manipal University, Gangtok, Directorate of Health Services (Medical Institutions), and the office of the District Medical and Health Officer, Ri Bhoi District Meghalaya, for support in carrying out this research.
Funding Statement
Nil.
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